UW Medicine Request for Minor Proxy MyChart Access 2026

1. Click ‘Get Form’ to open the UW Medicine Request for Minor Proxy MyChart Access in our editor.
2. Begin by filling out the 'Patient Information' section. Enter the child's name, date of birth, and the last four digits of their Social Security number.
3. Next, complete the 'Requestor Information' section. Provide your name, relationship to the child, your date of birth, address, email address, and phone number.
4. Ensure you have a valid photo ID ready to upload or present. This is required for verification purposes.
5. In the 'Declaration and Acknowledgement' section, read through each statement carefully. Confirm your understanding by checking the appropriate boxes.
6. Finally, sign and date the form at the bottom. Make sure all information is accurate before submitting it through our platform.

Start using our editor today to easily complete your UW Medicine Request for Minor Proxy MyChart Access form for free!