MyChart Proxy Forms
What is a proxy consent form?
With proxy access you can link your family's accounts to yours for convenient 24-hour access to many of the features you currently enjoy with your MyChart account.
Proxy Consent Forms should be returned to Our Lady of the Lake Physician Group Customer Service Department at 8415 Goodwood Boulevard, Baton Rouge, LA 70806.
What types of proxy are available?
Adult Access to Another Adult's MyChart Account
A capable adult can give permission to any other capable adult to access his/her MyChart account. This requires completion of the Adult Proxy Form with signatures from both individuals. Proxy access may be deactivated by request at any time.
Parent or Legal Guardian's Access to Their Child's MyChart Account
Adults with legal guardianship rights to a child may sign up for access to their child's MyChart account. This applies to parents or legal guardians of children between the ages of 0 and 14. Each parent must have their own MyChart account and complete the Child Proxy Form.
Parent or Legal Guardian's Access to Their Teen's MyChart Account
Once a child reaches the age of 15 a parent will only have partial access to their child's MyChart record. To request full proxy access to the MyChart record of your teen age child, please complete this form. The patient must sign this form and provide authorization for release of medical information in MyChart on the Teen Proxy Form. When your child reaches age 18, you will no longer have access to your child's MyChart record.
To see a preview of MyChart, please view our MyChart Patient Preview.