MyChart Proxy

What Are My Options?

There are two options regarding obtaining MyChart Proxy privileges. Parents, spouses, or legal representatives who wish to obtain MyChart Proxy privileges must complete a MyChart Proxy Access request either through an online form in MyChart or by completing the Request for MyChart Proxy Access paper form provided by the patient’s clinic. Both the patient and the proxy must have MyChart accounts. If the requesting individual does not have a MyChart account or a UTSW medical record, a medical record and associated MyChart account must be created and set up for that individual by the Health Information Management-Enterprise Master Patient Index (HIM-EMPI) Department.

Acceptable methods of submission are:

Electronic Submissions (Preferred)

Electronic submissions are completed via MyChart.

• If the MyChart Proxy requestor has an active MyChart account, please follow the steps below:
  • Log in to your MyChart account.
  • Select Menu.
  • Select Proxy Request under the blue “Sharing” header.
  • Complete the patient information form using the patient’s data.
  • Certify by checking the box that you have the legal right to the patient’s medical information.
  • Submit the request.
• If you do not have an active MyChart account and would like to sign up for MyChart Proxy, please follow the steps below:
  • Click on these hyperlinked words – electronic form – to begin the activation of MyChart.
  • Fill out the form using your own information.
  • You will be prompted to answer a selection of secure questions to verify your identity.
  • Once verification is complete, select Next.
  • Create your username and password.
  • Select Next.
  • Select if you wish to receive email notifications.
  • Sign into MyChart account to request proxy.
  • Now that you have an active MyChart account, follow the steps above for requesting MyChart proxy.
• Electronic submissions will route directly to the HIM-EMPI Department and will be reviewed and processed within 24-48 business hours if no additional information is required.
• If additional information is required, the HIM-EMPI Department will notify you or your desired proxy (e.g., a parent, spouse, or legal representative) and/or the clinic as appropriate.

Paper Submissions

• For paper submissions, the patient, parent, spouse, or legal representative must complete, sign, and return the form to the clinic.
• Download the form:
  • English
  • Spanish
• The HIM-EMPI Department will process paper submissions within 24-48 business hours if no additional information is required.
• If additional information is required, the HIM-EMPI Department will collaborate with the patient, parent, spouse, legal representative, and/or the clinic as appropriate.