Get Slucare Mychart

This guide provides clear instructions on completing the Slucare Mychart form online. Whether you are requesting access to another adult's MyChart record or authorizing a proxy, the following steps will assist you in navigating the form effectively.

Follow the steps to complete the Slucare Mychart form accurately.

1. Press the ‘Get Form’ button to retrieve the Slucare Mychart form and open it for editing.
2. Begin by filling out the Proxy Information section. Provide your full name (last, first, middle initial), the last four digits of your Social Security Number, date of birth, street address, city, state, zip code, email address, and phone number. Ensure that all entries are clear and legible.
3. Next, complete the Patient’s Information section. This requires the patient's full name as well as their date of birth, street address, city, state, zip code, email address, and phone number. As with the previous section, clarity is essential.
4. Review the MyChart Terms and Agreement. It is vital that you understand the compliance requirements before signing. If you agree, proceed to provide the patient's signature (or that of an authorized person) and indicate their relationship to the patient.
5. In the Adult Proxy Authorization for Release of Medical Information section, repeat the patient's name and provide the last four digits of their Social Security Number (optional). Fill in the name of the proxy and confirm the patient’s authorization by signing and dating the form.
6. Once all information is accurately filled in, review the document to ensure that no fields are left incomplete. Save the changes or download a copy of the form for your records.
7. Finally, submit the completed form either by faxing it to 314-977-6021 or mailing it to Health Information Management, 3660 Vista Ave, Suite 107, St Louis, MO 63110.

Complete your Slucare Mychart documents online for convenient access to health information.