Get Uva My Charts

Filling out the Uva My Charts form online ensures seamless access to your health information. This guide provides clear, step-by-step instructions tailored to help you complete the form accurately and efficiently.

Follow the steps to complete the Uva My Charts form online.

1. To begin, click the ‘Get Form’ button to access the Uva My Charts online form. This will open the form in a digital format, allowing you to fill it out conveniently.
2. Complete the patient's personal information section: Enter the patient's name, medical record number, date of birth, and gender. Ensure accuracy as this information is critical for identification.
3. In the address field, write the patient's complete address. If available, include the patient's email address, or indicate if none applies.
4. Provide details for the adult seeking proxy access. Enter their name, phone number, and address. If applicable, include their date of birth and email address.
5. Indicate whether the adult proxy is a UVA patient by providing their medical record number, or state if they are not a UVA patient.
6. Select the relationship of the adult seeking proxy access to the patient by checking the appropriate box (e.g., spouse, son/daughter, or specify another relationship).
7. Both the patient and the adult proxy must read and understand the terms regarding MyChart access. Sign and date the section provided for both parties.
8. For validation, staff will check that proxy identification has been validated. Indicate the role of the staff member that validated the access.
9. Complete the staff signature section, including the name, role, and date for record-keeping purposes.
10. Once all sections are filled out, review the form for completeness and accuracy. Finally, submit the completed form via U.S. mail, email, or fax using the provided contact details.

Complete your Uva My Charts form online today for efficient management of your health information.