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Request Access to Another Patient's Health Record (Proxy)

Would you like to gain access to your child's MyChart health record? If you already have a MyChart Account you can log in and request with our online form. Select the 'Personalize' option under the 'Settings' menu. Otherwise, download this PDF form and either drop it off in person at your child's health care provider's office or send it to the Rush Copley Health Information Management office. Rush typically processes requests received by email or fax within one business day. Requests submitted by mail may take up to five business days after receipt to process. Please note: Full Access in MyChart is only available for children under 12 years of age; Limited Access to allergies, immunizations and growth chart is available for children between the ages of 12 - 17.

Online Child Proxy Request Form
Child Proxy Request Form (PDF) Child Proxy Request Form (PDF)

Would you like to gain access to another adult's MyChart health record? Download this PDF form and either drop it off in person at the patient's health care provider's office or send it to the Rush Copley Health Information Management office (see form for the office's contact information). Rush typically processes requests received by email or fax within one business day. Requests submitted by mail may take up to five business days after receipt to process. Please note: The adult patient must provide signed consent, or you will need to provide documentation that you, the proxy, are the patient's legal guardian or hold durable power of attorney for the patient's health care.

Adult Proxy Request Form (PDF) Adult Proxy Request Form (PDF)