MyChart Adult Proxy Access Form - Swedish Hospital 2026

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The MyChart Adult Proxy Access Form allows caregivers, legal guardians, or authorized adults to request online access to the medical records of another adult they assist. The patient must sign the form to authorize this access, and if they are unable to do so, documentation of guardianship or power of attorney is required. The document outlines the process for revoking access, the responsibilities of both parties regarding sensitive health information, and the need for compliance with MyChart's Terms and Conditions.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Patient Information' section. Clearly print the patient's name, date of birth, and social security number. Ensure that the street address, city, state, and zip code are accurately entered.
Read through the consent statements carefully. Acknowledge your understanding by checking the appropriate boxes regarding medical emergencies and personal health information.
In the 'Proxy’s Information' section, provide all required details for the adult requesting access. This includes their name, date of birth, social security number, address, phone number, and relationship to the patient.
Ensure both the patient and proxy sign and date the form in their respective sections to validate authorization.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I get proxy access on MyChart?

Access is obtained by completing the MyChart - Teen Proxy Access Authorization form. This form must be signed by the teen, parent or legal guardian, and the teens primary care provider or pediatrician. Teen Proxy access is automatically terminated on the teens 18th birthday.

How do I get proxy access?

To give someone else proxy access to your account, please submit the request directly from your MyChart account. Go to Your Menu Share My Record. Under Who Can See My Record?, click Invite Someone. Follow the instructions to send an email invitation to the person who youd like to have access to your MyChart account.

How to give proxy access in MyChart?

Setting up proxy access In most cases you will need to contact the GP surgery of the person who wants help, to ask for proxy access. The GP surgery will make sure the person giving access understands and agrees to it, where needed. You may both have to fill in a form and prove who you are using photo ID.

What eMR does Swedish use?

Orientation to Electronic Medical Record (EMR) Charting Swedish uses the Epic clinical information system for all chart functions including order entry.

What is proxy access to a patient portal?

Proxy access allows a person to use the patient portal to view another persons information. Patients may grant access to a designated individual, such as a spouse or medical decision caregiver.

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