UW Medicine Request for Minor Proxy MyChart Access 2026

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The document is a request form for birth or adoptive parents or guardians to gain proxy access to a child's MyChart online medical record for children under 13 years old. It outlines the necessary patient and requestor information, legal declarations, and requirements for documentation to establish the requestor's authority. The form emphasizes the importance of confidentiality, the conditions under which access may be revoked, and the implications of accessing sensitive health information.

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

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Versions	Form popularity	Fillable & printable
2020	4.5 Satisfied (42 Votes)

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What is the first step when granting MyChart 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 do you grant someone access to your MyChart?

Request Full Access to Another Adults MyChart Record The patient will go to Your Menu and choose Share My Record, click on Give friends and family access at the bottom of the page.

How to set up proxy access?

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.

How to add child to uw health MyChart?

Step 2: Request proxy access to your child Log into your account at uwhealthmychart.org. (The request is not available on the mobile app). Click Request Access to Another Account (proxy) (upper right), and then Request Access (bottom of screen). Follow the steps online.

How to give proxy access in MyChart?

Adult proxy Adults aged 18 and older can share their health information with another adult by doing the following: Log into your MyChart account. Go to the Menu and choose Sharing Hub. Select Manage Friend and Family Access. Both parties MUST have an active Prisma Health MyChart account.

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How do I access MyChart uw medicine?

If you have an activation code from your doctor Look for an activation code on your After Visit Summary or in an email or text message from your healthcare organization. Follow the instructions provided with your activation code to create your MyChart account. Go to MyChart. Enter your: Create a username and password.

What do I do if I cant log into MyChart?

On the MyChart login screen, click the Forgot Username? or Forgot Password? link for help. If you forgot both your username and password, start with the username first. You will be prompted to answer some security questions to verify your identity so you can recover your username or password.

UW Medicine Request for Minor Proxy MyChart Access 2026

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How to use or fill out UW Medicine Request for Minor Proxy MyChart Access with DocHub

See more UW Medicine Request for Minor Proxy MyChart Access versions

Complete this form in 5 minutes or less

Got questions?

What is the first step when granting MyChart proxy access?

How do you grant someone access to your MyChart?

How to set up proxy access?

How to add child to uw health MyChart?

How to give proxy access in MyChart?

Security and compliance

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