Get Mychartsaintfrancis

This guide provides clear, step-by-step instructions on how to fill out the Mychartsaintfrancis form for proxy access to another adult’s MyChart record. By following these steps, users can ensure a smooth and efficient process.

Follow the steps to successfully complete the Mychartsaintfrancis form.

1. Click the ‘Get Form’ button to obtain the Mychartsaintfrancis form and open it for editing.
2. Fill out the proxy information section clearly. This includes the proxy’s date of birth, name (last, first, middle initial), phone number, email address, and address details. Be sure to check the appropriate box indicating the preferred phone type (home, mobile, or work) and whether the proxy is a patient within the Saint Francis Health System.
3. Complete the patient’s information section with accurate details for the individual whose MyChart record you are requesting access to. Ensure the patient’s date of birth, name, phone number, and address are provided. Again, check the relevant box regarding their status as a patient within the Saint Francis Health System.
4. Read through the MyChart terms and agreement carefully. Ensure you understand all responsibilities and limitations regarding the use of MyChart and access to medical information.
5. Sign and date the form in the designated sections for both the proxy and the patient (or authorized person). If applicable, indicate the relationship to the patient in the specified area.
6. Attach any required documents such as a government-issued ID and any legal paperwork verifying the proxy's relationship to the patient, such as guardianship papers or power of attorney.
7. Return the completed form along with any attachments to your Warren Clinic provider or another Saint Francis healthcare provider. If there is no existing provider, send it to the Saint Francis Health Information Department.
8. Once submitted, monitor for any communication regarding the verification of your request. You may also confirm the proxy access status through appropriate channels.

Complete your Mychartsaintfrancis form online today for efficient access to the necessary medical records.