Myosfchart 2025

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The document outlines the process for an adult to request access to another adult's OSF MyChart account through a proxy. It includes a form that must be completed by both the patient and the proxy, requiring personal information and signatures. The document emphasizes the importance of confidentiality, security of passwords, and the voluntary nature of participation in OSF MyChart. It also details the rights and responsibilities of both the patient and the proxy regarding access to medical information.

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Click ‘Get Form’ to open the myosfchart in the editor.
Begin by entering the Patient’s Information. Fill in all required fields, including the patient's name, last four digits of their Social Security Number, date of birth, gender, and address details.
Next, provide Proxy Information. Again, ensure all fields are completed accurately for the proxy's name, Social Security Number, date of birth, gender, contact number, and address.
Review the OSF MyChart Terms and Agreement carefully. Ensure that both the patient and proxy understand their responsibilities regarding access to medical information.
Finally, both the patient and proxy must sign and date the form at the designated areas to confirm their agreement to the terms outlined.

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