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Release of Information & My Chart

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  4. Release of Information

  • Adult Proxy Access to MyChart by Adult
  • Authorization for Access by Hospital Education
  • Authorization for Release of Medical Information
  • Authorization for Sharing of Information: Patient to Patient
  • Custody - Managing Peds Custody Docs SW.pdf


  • Non-HIS Preapproved Release of Information Scenarios/0340
  • Obtaining Copies of Your Medical Record
  • Parent_Legal Guardian_Other Adult Proxy Access to Adolescent MyChart (Child aged 13-17 Yrs old)
  • Parent/Legal Guardian Proxy Access to MyChart (Child under 13 Yrs Old)
  • Parent/Legal Guardian Proxy Access to MyChart (Child under 13 Yrs Old)Spanish)
  • Parent/Legal Guardian_Other Adult Proxy Access to Adolescent MyChart ( Child aged 13-17 Yrs Old/Spanish)
  • Proxy Access to My Chart for Caregivers
  • Proxy Access to My Chart for Caregivers(Spanish)
  • Request for Amendment of Health Information
  • Request for an Accounting of Disclosures
  • Request for Medical Records (non-patient care purposes)
  • Request for Non-Disclosure of Health Information to Health Plan
  • Request for Restriction on Uses & Disclosures of Health Information
  • Sensitive Notes, Open Notes, BTG...
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Health Information and Technology

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