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Uest and authorization form is received. PATIENT TO BE ENABLED FOR PROXY ACCESS: Name: Date of Birth: Email: Address/Phone #: / PROXY (PARENT/LEGAL GUARDIAN): I am requesting access to the medical information available on MyChart at NYU Langone for the patient named above and agree to abide by the above terms and conditions of MyChart at NYU Langone and all other terms and conditio.

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How to fill out the MyChart NYU online

This guide provides step-by-step instructions for completing the MyChart NYU online proxy access request and authorization form for children aged 0-11 years. Ensuring that the form is filled out correctly will facilitate access to your child's medical information efficiently and securely.

Follow the steps to complete the MyChart NYU form.

  1. Press the ‘Get Form’ button to obtain the form. This will allow you to open the document in the appropriate editing platform for your convenience.
  2. Begin by providing the information for the patient who will be enabled for proxy access. This includes the patient’s name, date of birth, email address, and address along with the phone number.
  3. Next, move to the section designated for the proxy, who is typically the parent or legal guardian requesting access. Enter your name, date of birth, email address, and address with the corresponding phone number.
  4. After entering personal information, you will need to sign the form to authorize the access. Ensure you also indicate your relationship to the patient clearly.
  5. Review all entries carefully to confirm that all required fields are completed accurately. Any errors may delay the authorization process.
  6. Once all information has been verified, you can save the changes, download the form, print it out, or share it with your provider's office as instructed.

Complete your MyChart NYU proxy access form online today to ensure seamless access to your child's medical records.

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If they are a patient at NYU Langone, they can create their account online. If they are not a patient at NYU Langone, they must call our MyChart Help Desk at 866-262-6458 so that we may create an account for them.

If you are a patient at NYU Langone and don't yet have an account, you can create your account online. If you are not a patient at NYU Langone, please call our MyChart Help Desk at 866-262-6458 so that we may create an account for you.

Our patient portal, NYU Langone Health MyChart, gives you access to schedule or change appointments, view your test results, communicate with your doctor, and more.

Download our app and sign in with your NYU Langone Health MyChart username and password to stay connected to your care. If you don't yet have a MyChart account, you can create your account now.

Tap Add a document or Image to upload an image or document for your upcoming appointment. You will need to have image or document files on your mobile device. If you do not have images available, you will have the option of capturing images or documents using your mobile device during the upload process.

Who do I contact if I have questions about enrolling? Please call our NYU Langone Health MyChart Patient Help Desk at 866-262-6458.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232