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Web To Request Proxy Access, Please Complete This Form And Either Submit It At Your Clinic Visit Or To Health Information Services (His), Or Fax, Mail, Or Email (Either As A Scanned.
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This Form Is An Authorization Used To Designate Another Adult As My Mychart Proxy And Give.
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Web Adult Proxy Access To Mychart By Another Adult Proxy Authorization Form Instructions For Completing This Form:
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Web Fill Out The Mychart Account Request Form You'll Get An Activation Code And Instructions For Making Your Personal Username And Password You Might Also Get An Activation Code.
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