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Get Mychart Park Nicollet
How it works
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Open form follow the instructions
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Easily sign the form with your finger
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How to fill out the MyChart Park Nicollet online
This guide provides clear instructions on completing the MyChart Park Nicollet membership request form online. By following these steps, users will be able to efficiently gain access to their medical records through the MyChart platform.
Follow the steps to complete your MyChart request
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Enter your personal details in the 'Requestor Information' section, including your date of birth, full name, address (street, city, state, and ZIP code), last four digits of your Social Security number, and phone number.
- Select the type of account you are requesting by checking only one box: Individual account request, Shared account request, or Proxy account request.
- If requesting an individual account, print your name, enter your date of birth, and provide a reason for any previous deactivation if applicable. Sign and date the form.
- For a shared account request, write your name, the name of the person you want to grant access to, and both parties need to sign and date the form.
- If requesting a proxy account, provide the name and birthdate of the patient you are accessing records for. The adult requesting access must sign and date the form.
- Read and understand the Terms and Agreements section, then sign and date to acknowledge agreement.
- Click the PRINT button below to print the form. Sign the necessary sections and then submit the completed form by mailing or faxing it to the relevant MyChart services.
- After submitting the form, allow five to ten business days for processing. You will receive a letter with a one-time access code, which is valid for 30 days.
Complete your MyChart membership request online today for easy access to your health records.
To obtain your MyChart Park Nicollet account, visit the MyChart website and look for the option to sign up or log in. If you have not yet created an account, follow the instructions to register. Once set up, you can manage your health records, appointments, and messages conveniently.
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