Proxy Access Forms


Forms for Proxy Access
  • Adult Proxy - Adults can access the online medical record with the patient's consent.
  • Caregiver Proxy - Caregivers can access the online medical record of a patient if the patient authorizes.
  • Child Proxy - Birth parents or legal guardians can access the online medical record for their children who are under 14 years old.
  • Teen Proxy - For children who are 14-17 years old, a birth parent or legal guardian can access the online medical record with the child's consent. With the consent of a parent or legal guardian, children 14-17 years old can access their own online record.
  • Power of Attorney Proxy - Caregivers can access the online medical record of a patient if the patient authorizes. In the case of Power of Attorney (POA), the caregiver can gain access by providing appropriate Medical POA documentation.