Error: Please enable cookies to log in to MyChart.

MyChart Enrollment Forms

MyChart offers patients personalized and secure on-line access their medical records. It provides a secure method for patients to help manage and receive information about their health.

MyChart Proxy access provides an individual who is authorized access to a patient’s records or to perform activities on their behalf (e.g. parent, guardian, patient representative, healthcare surrogate, etc.).

To establish MyChart Proxy access, review and fill out the forms required based on the MyChart Proxy access needed and return them to your Franciscan Physician Network provider office or Franciscan Health hospital medical records department for setup.

Adolescent Patient MyChart Access

(patients 12 to 17 years + 364 days)

Child Patient - Parent/Guardian Proxy Access

(patients 0 to 11 years + 364 days)

Adolescent Patient - Parent\Guardian Proxy Access – Limited Access

(patients 12 years to 17 years + 364 days)

*Note: New regulatory requirements impacting Proxy Access for Adolescents go into effect on 11/2/2020. Parents/guardians with Proxy Access prior to 11/2/2020 will continue with Limited Access and will need to complete the forms found in the ‘Adolescent Patient - Parent\Guardian Proxy Access – Full Access’ section if requesting full access to the information.


Adolescent Patient - Parent\Guardian Proxy Access – Full Access

(patients 12 years to 17 years + 364 days)

Adult Patient - Proxy Access

Adult/Adolescent Patient without Decisional Capacity – Proxy Access

Adult/Adolescent Patient - Patient Representative or Healthcare Surrogate Proxy Access