A “proxy” is a person who has been given permission to access the patient's MyChart account and medical information available within MyChart.

Proxies other than the parent must provide documentation that establishes they are the patient’s legal guardian or healthcare representative. If guardianship and/or foster status changes, it is the responsibility of the proxy to notify us immediately.

I understand that: (1) MyChart may contain limited medical information and may not reflect the complete contents of the medical record; (2) My activities within MyChart may become part of the above-named patient’s medical record; (3) By providing access to a proxy, any information maintained in the above-named patient’s record may be available to the listed proxy unless I expressly request to my provider at the time of service that it not be shared. This may include, but is not limited to, information related to HIV test results and/or diagnosis; other sexually transmitted diseases; mental health diagnosis or treatment information; genetic testing information; and drug/alcohol diagnosis, treatment, or referral information; (4) I may revoke this authorization at any time via the MyChart portal or by contacting Columbia Health Services; and (5) My agreement will not affect my ability to obtain healthcare services or reimbursement for services.