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MyChart ® Epic Systems Corporation

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MyChart Proxy Access
What is proxy access?
Proxy access allows you to link your family’s accounts to yours for convenient 24-hour access to many of the features offered through your MyChart account. Depending on the type of proxy granted, you may have access to appointments, immunization records, presecription refills, secure messaging with the patient's care providers, and more.

What types of proxy are available?
There are four levels of proxy access available:

Adult-Adult: Access to another adult's MyChart record with the written authorization of the patient.

Adult-Child (Access to your minor child’s MyChart record): Please note the following age range limitations for MyChart. These age range limitations do not affect any legal right you have to access your child’s record by other means.

If your child is age 0-12: You will be granted full access to your child’s MyChart record.

If your child is age 13-17: You will be granted partial access to your child’s MyChart record (e.g., appointment scheduling, immunizations). Partial access is due to privacy laws.

Once your child reaches age 18, you will no longer have access to your child’s MyChart record.

Legal Guardian: Access to the MyChart account of a patient for whom you have legal authority to make health care decisions.

I want to get / give proxy access How do I do it?
To gain proxy access, the appropriate form(s) below should be completed mailed, faxed or brought to:

Health Information Management Identity – Data Integrity
N17 W24100 Riverwood Drive, Suite 200
Waukesha, WI 53188
Fax: (262)544-9489


Proxy Forms

If you are a parent or guardian and would like access to your minor child's MyChart account, download and complete:

- MyChart Proxy Access Request form

If you are an adult and would like access to another adult's MyChart account, download and complete:

- MyChart Proxy Access Request form

- MyChart Adult Proxy Authorization Release of Information (complete by patient)

If you are a legal guardian for an adult and would like access to the adult's MyChart account, download and complete:

- MyChart Proxy Access Request form

- MyChart Adult Proxy Authorization Release of Information (complete by patient) - Please provide legal documentation to support your Legal Guardianship or Power of Attorney for access to medical health records/information.

Next steps
Once we receive your consent form and your proxy access is approved, we will U.S. mail access instructions and a personalized secure access code to the address you provided on the form.

Who can I contact if I have questions?
Please feel free to contact us if you would like the consent form mailed to your home address or if you have any questions about this program. Members of our MyChart support team are available to assist you 24-hours a day, 7-days a week. You may call (877) 873-6305.