Get Mychart Everett Clinic Washington

Filling out the MyChart Everett Clinic Washington Child Proxy Form is an essential step for parents or guardians seeking access to their child's medical information. This guide provides clear, step-by-step instructions to facilitate the process and ensure you complete the form accurately.

Follow the steps to successfully complete the Child Proxy Form.

1. Click ‘Get Form’ button to obtain the form and open it for completion.
2. In the designated area, clearly print your child's name and date of birth to ensure accurate identification.
3. Provide the Medical Record Number (MRN) of your child, if available, for easier reference to their medical record.
4. Complete the Parent/Guardian Information section by filling out your name, date of birth, street address, city, state, and zip code. Make sure to print your information legibly.
5. Enter your email address and phone number where you can be reached, facilitating communication regarding your child's account.
6. Fill in the required information for the proxy access, which includes your child's name and date of birth. Remember, a separate form is needed for each child.
7. Review the MyChart Terms and Agreement carefully, ensuring you understand the implications of granting access and your responsibilities.
8. Sign and date the form, indicating your relationship to the patient, as this information is necessary for processing your request.
9. Once completed, return all forms to The Everett Clinic either by mail or fax at the provided address and fax number.
10. After submission, monitor your email or phone for updates regarding the activation of your child's MyChart account.

Get started by completing the MyChart Everett Clinic Washington Child Proxy Form online today.