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How to fill out the MyChart UTMB online
Filling out the MyChart UTMB Proxy Access Request form is a straightforward process designed to facilitate authorized access to a patient's medical information. This guide will provide you with detailed instructions on how to complete each section of the form accurately and efficiently.
Follow the steps to complete the MyChart UTMB form online.
- Click ‘Get Form’ button to download the MyChart UTMB Proxy Access Request form and open it for editing.
- Enter the patient information in the designated fields, which includes the patient's name (last, first, middle initial), any previous names used, address, date of birth, and optional UH number.
- Provide the proxy information in the next section by entering the proxy's name, address, date of birth, email address, phone number, and UH number if available. Indicate whether the proxy has an active MyChart account.
- Select the appropriate type of proxy access you are requesting by checking one of the following options: Adult-Adult, Adult-Child, or Legal Guardian. Ensure you provide any required documentation if selecting Legal Guardian.
- Read the disclosures regarding protected health information and understand the implications of granting proxy access. Acknowledge your understanding by signing and dating the form in the specified areas.
- If you have provided documentation supporting your authority to access the patient’s health information, ensure these documents are accurate and include them with your submission.
- Finally, save your changes to the form, and choose to download, print, or share the completed MyChart UTMB Proxy Access Request form as needed.
Complete your MyChart UTMB Proxy Access Request form online to ensure timely access to necessary medical information.
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To upload documents to a document portal, first, access the specific portal you are using. Most portals, including Mychart Utmb, have an 'Upload' button prominently displayed. After selecting it, choose the files from your device, and follow any additional prompts to complete your upload.
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