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The document is a Child Proxy Form for accessing a child's MyChart account at The Everett Clinic. It outlines the process for parents or guardians to obtain access, including required information and age-related limitations on access. The form emphasizes the importance of confidentiality, security of passwords, and the conditions under which access may be granted or revoked. It also includes terms and agreements regarding the use of MyChart and notes that the authorization will expire if not activated within 90 days.

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Versions	Form popularity	Fillable & printable
2011	4.8 Satisfied (288 Votes)

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