MyChart Proxy Access

If you would like to obtain access to a fam­i­ly member’s MyChart account, please com­plete the appro­pri­ate​proxy form below based on the patient’s age.

For chil­dren under 12, proxy access allows a par­ent or legal guardian to log into their per­son­al MyChart account and view infor­ma­tion regard­ing their child. Per Illi­nois state guide­lines, upon a child’s 12^th birth­day, a par­ent or legal guardian will still have access to appoint­ment his­to­ry, immu­niza­tions, and mes­sages but will have lim­it­ed access to the child’s med­ical record infor­ma­tion. Full access can be grant­ed for chil­dren between the ages of 12 and 17 using the Teen Proxy form with the sig­na­ture of the child, par­ent or legal guardian, and a witness.

Once a patient turns 18, a par­ent can get access to their account with the patient’s autho­riza­tion and com­ple­tion of the adult proxy form. This form can also be used to request proxy access to anoth­er adult’s MyChart account, such as a spouse, part­ner, or par­ent. Adult proxy access can be applied online through an active account for imme­di­ate access and a paper­less experience.

Com­plete the Child Proxy Form online
(Alter­na­tive: Down­load & E‑Mail/​Fax Child Proxy Form)

Down­load Child Proxy Form (Span­ish)

Down­load Teen Proxy Form

Down­load Teen Proxy Form (Span­ish)

Down­load Adult Proxy Form

Down­load Adult Proxy Form (Span­ish)

Down­load Proxy Revo­ca­tion Form

Down­load Proxy Revo­ca­tion Form (Span­ish)