Get To Get Patient Sign Up Form - English - Mychart

This guide provides step-by-step instructions for completing the To Get Patient Sign Up Form - English - MyChart online. Whether you are a parent or legal guardian seeking to provide your child with access to their medical records, this guide will help ensure you correctly fill out the necessary form details.

Follow the steps to successfully complete the sign-up form.

1. Press the ‘Get Form’ button to acquire the form and open it in an appropriate document editor.
2. Begin by entering the adolescent patient's information, including their full name, date of birth, address, and social security number (last four digits only). You will also need to specify the patient's sex by selecting either the appropriate checkbox.
3. Next, provide the email address for the adolescent patient. This address is where they will receive notifications related to MyChart.
4. Now, switch to the adult requestor's section. Fill in the legal guardian's full name, date of birth, and address. Include the social security number (last four digits only) and select the guardian's sex.
5. Read the important information provided about MyChart carefully. It outlines the limitations of the service, privacy considerations, and circumstances under which access may be revoked.
6. In the signature section, the legal guardian must affirm their role and provide their signature along with the date and time of signing.
7. Finally, review the completed form for accuracy, then save your changes. You may then choose to download, print, or share the form as needed.

Complete your MyChart patient sign-up form online today to ensure your child's access to their healthcare information.