Get Myuhealthchart

This guide provides a detailed overview of how to complete the MyUHealthChart proxy form online. By following the steps outlined below, you can ensure that you correctly fill out the necessary information to gain access to your child’s or a minor's health records.

Follow the steps to successfully fill out the MyUHealthChart proxy form.

1. Click ‘Get Form’ button to obtain the Child Proxy Form and open it in the editor.
2. Begin by providing your information as the parent or guardian. This includes your name (last, first, middle initial), the last four digits of your Social Security Number, your street address, email address, date of birth, city, state, zip code, and phone number. Ensure that all sections are printed clearly.
3. Fill in the information for each minor child you are requesting access for. You will need to enter their name (last, first, middle initial), the last four digits of their Social Security Number, and their date of birth. If you have more than four children, you will need to print an additional form.
4. Indicate your relationship to the minors listed. Select one option from the provided choices, such as 'parent,' 'legal guardian,' or 'non-custodial parent.' If applicable, provide copies of any legal documents that confirm your authority.
5. Answer the question regarding any court orders that may limit access to the minor’s medical records. If a court order exists, ensure to provide the required legal documentation.
6. Review the MyUHealthChart Terms and Agreement carefully. It is essential to understand the limitations and responsibilities involved with accessing the medical records.
7. Finally, sign the form where indicated, include your relationship to the patient, and date the form. Make sure all required sections are completed before submission.
8. After filling out the form, you can save the changes, download, print, or share it as necessary, and return it to the specified address.

Complete the MyUHealthChart proxy form online today to gain access to your child's health information.