MyChart authorization proxy access form - OhioHealth 2025

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4.4 out of 5

54 votes

The document is an Adult Proxy Access Form for MyChart, allowing a parent, legal guardian, or caregiver to request access to an adult patient's medical information with their consent. It explains the process of linking the patient's MyChart account to the proxy's account, enabling the proxy to view and manage the patient's health information. The form requires personal details of both the proxy and the patient, along with signatures for authorization. It also provides submission instructions for the completed form.

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Versions	Form popularity	Fillable & printable
2023	4.4 Satisfied (54 Votes)
2018	4.7 Satisfied (41 Votes)

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Got questions?

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

What is proxy access to patient portal?

OhioHealth MyChart offers the same access to preregistration and your medical records that you had with myOhioHealth. You also can communicate with your doctor, access your test results, request prescription refills and more.

How do I give proxy access to MyChart?

A proxy is someone who can have access to another patients health information. If you are a parent or a care partner of a Health Services patient and they would like to grant you access to their medical information via LA Health Portal, please call or visit a Health Services clinic or hospital.

What is Ohio Health MyChart?

Patients with OhioHealth MyChart can request* electronic medical records through their account. Requests are usually completed within two business days. OhioHealth MyChart is a simple, secure and convenient way to request electronic medical records.

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