MyChart Caregiver Access Request

Proxy access to a family member's Memorial MyChart health information offers the following benefits:

• View your family's medical information online
• Review medications and health history
• Receive most test results online
• Review discharge instructions and health topics
• Stay in touch with your family's physicians
• Send secure messages to a Memorial MyChart doctor
• Request medication renewals online
• Manage your family's appointments
• Request an appointment
• View details of past and upcoming appointments

How to Get Started

Step 1 The person requesting proxy access to a family member's or child's account must have their own personal Memorial MyChart account.

If you don't have a Memorial MyChart account, you can get one by Requesting an activation code.You can also obtain a MyChart activation code from your participating MyChart doctor's office.

Once you activate/have access to your personal MyChart account follow step 2 for requesting proxy access for an adult, Child (Under age 13) or Teen (13-18)

Step 2 Once you have access to your personal MyChart account you can request proxy access to either an adult account or a child account.

For Proxy access to an adult account

There are 2 options to request and grant proxy access for an adult patient's MyChart

Option 1 — MyChart to MyChart (quicker access) — A patient with an active MyChart Account can grant proxy access to a caregiver/support person's MyChart account. The Patient granting access must follow these steps:

1. The Patient granting access must login to their MyChart account on your computer at mychart.mhs.net or on the mobile app.
   Select the Menu icon at the top left corner of your screen
   Under Sharing, select Share My Record
2. Select Friends and family access  Click on Invite someone.
3. Fill out all fields to send someone an invitation to receive proxy access to your account.
4. Read and agree to the terms and conditions and click on the checkbox and click on send the invites.
5. The person receiving access will be sent an email invitation. They will need to login to MyChart and accept the invitation as a proxy.

Option 2 — Complete and submit the proxy request forms.

To request access to an adult family member’s Memorial MyChart account, complete and submit the forms below in-person at your Memorial provide's office. Both the patient and the person requesting access must be present and have a medical record (MRN) with Memorial. If you are unable to come in person email the form to mychart@mhs.net with a picture of a government issued photo ID (This method requires a review by an authorized Memorial employee and can take 1-2 business days from the moment the forms are submitted).

• Adult Proxy Request (PDF)
  To be completed by the adult requesting access
• Adult Proxy Authorization (PDF)
  To be completed by the patient

Proxy Access to a Child's Account (Under age 13)

There are 2 options to request proxy access for a child's MyChart information.

Option 1 — Online Request Form — A parent with a MyChart account can request proxy access from within their MyChart account

1. Login to your personal MyChart account at mychart.mhs.net (this step is not available on the app)
   Select the Menu icon at the top left corner of your screen
   under the Account Settings section, select  Request access to a minor's account
2. Click on Request access to a child's (Under age 13) MyChart account.
3. Complete the form with your child's demographic information.
   Important: Please make sure to read the statement and click to acknowledge to submit the request.
4. Submit the request. Please allow 24-48 business hours for the request to be reviewed.

Option 2 — Paper form — For minors that don't have an ongoing Memorial provider (for example patients that visited the labs or emergency room)

Please complete the Child Request for Parental Proxy Form (PDF). Attach it with the parent or guardian government issued photo ID and email it to us at mychart@mhs.net for assistance. Please allow a 3 business day for a reply.

Proxy Access to a Child's Account (13-18th Birthday)

Access to a child’s Memorial MyChart health information changes when he or she turns 13, because state and federal law protect the privacy of pediatric patients seeking medical treatment for pregnancy, sexually transmitted disease, substance abuse, and mental health issues.

Teen consent is required for parents or legal guardians to access their teen’s MyChart health information. Teen MyChart Access is only available to teens who grant consent to a parent or legal guardian; however, a teen may revoke such consent at any time. Teen MyChart Access expires at age 18.

There are 2 options to request proxy access for a child's MyChart information.

Option 1 — Online Request Form — A parent with a MyChart account can request proxy access from within their MyChart account

1. Login to your personal MyChart account on your browser at mychart.mhs.net (this step is not available on the app)
   Select the Menu icon at the top left corner of your screen
   under the Account Settings section, select select Request access to a minor's account
2. Click on Request access to a teen's (13 to 18th birthday) MyChart account.
3. Complete the form with your child's demographic information.
   Important: Please make sure to read the statement and click to acknowledge to submit the request.
4. Submit the request. Please allow 24-48 business hours for the request to be reviewed. We will contact your teen to get verbal consent to grant you access.

Option 2 — Paper form — For minors that don't have an ongoing Memorial provider (for example patients that visited the labs or emergency room)

Please complete the Teen Proxy Authorization form (PDF). Please make sure it includes your teen's signature. Attach the form with the parent or guardian goverment issued photo ID and email it to us at mychart@mhs.net for assistance. Please allow a 3 business day for a reply.