Skip to main content

<<Back to Authorization Form

Caregiver Access to the Online Medical Record of a Patient

Online Submission Requirements and Procedures

Caregivers can access the online medical record of a patient if the patient authorizes. There are three options for viewing the online medical record: MyChart, a website accessible through the Internet, or via mobile app downloadable from iTunes or Google Play, and MyChart Bedside, a tablet mobile app available during some hospital stays. Please complete the form and then click 'Continue' at the bottom of the form. You must then immediately print the form to be signed and mailed or faxed to the address listed. You will be notified via a message when we have processed your request.

Requirements for online access to a patient's record:

  • Individual requesting access must have signed consent from the patient
  • Caregiver Authorization Form must be completed in all required areas, signed and mailed or faxed to the address on the bottom of the form
  • Each caregiver requesting access must have their own account or an account will be established by appropriate staff. If using MyChart Bedside, each individual requesting access must set up MyChart Bedside account with staff.

I understand that:

  • I must have a MyChart account or an account will be established for me
  • To use MyChart, I must log in or register with my own Username & Password
  • To use MyChart Bedside, I must log in with my own pin number (set up with hospital staff)
  • I agree to abide by the terms and conditions of the suite of patient portal products (e.g. MyChart, MyChart Bedside)
  • The suite of patient portal products are not to be used in an emergency

Caregiver access to a patient's record is revoked when the patient or physician submits a request or revokes access online. Your health care organization reserves the right to revoke online access to medical information at any time.

Communications on behalf of the patient must be sent from the patient's record and responses will be received in the patient's record. Email alerts will be sent to the email address entered in the patient's record.

Each record that you have been granted access to will display in the dropdown located at the top-right of the home screen.

If you already have a patient portal account, you will receive a message when access to the patient's record becomes available, typically 5 to 7 business days after completed authorization form is received.

If you do not have a patient portal account, you will receive an Activation Letter with instructions on how to create one. Please promptly activate your account.

If you are requesting access to view the patient's information in MyChart Bedside, the authorization will be processed in 1-2 business days after the completed authorization form is received.

<<Back to Authorization Form