university health care system - mychart patient...the university health care system mychart website...

51
University Health Care System Augusta, Georgia www.uhmychart.org 706-774-5800 MyChart Patient User Guide Scan this code for MyChart Mobile

Upload: others

Post on 30-May-2020

5 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

1 | P a g e

University Health Care System

Augusta, Georgia

www.uhmychart.org

706-774-5800

MyChart Patient User Guide

Scan this code for MyChart Mobile

Page 2: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

2 | P a g e

Table of Contents

MyChart General Information ............................................................................................................4

What is MyChart ............................................................................................................................................4

Important Numbers and Information ..............................................................................................................4

Using the UH MyChart Website ......................................................................................................................5

MyChart Account Creation and Profile ................................................................................................6

Instant Activation ..........................................................................................................................................6

Activate a MyChart Account via Internet ........................................................................................................6

Activate a MyChart Account via Mobile App ...................................................................................................7

MyChart Account Profile ................................................................................................................................7

Retrieving your MyChart Username and Password Reset ................................................................................8

Sharing and Linking University Health Care System MyChart with other Organizations ........................9

Lucy and MyChart Central ..............................................................................................................................9

How do I sign up for Lucy and MyChart Central ...............................................................................................9

Link My University Health Care System MyChart Account with Another Organization’s MyChart Account ...... 12

Accessing Lucy ............................................................................................................................................. 13

How to share my Lucy data with University Health Care System Providers and/or another facility ................. 14

Share Your Record ....................................................................................................................................... 15

View, Download, and Send Visit Records ...................................................................................................... 16

Accessing University Health Care System Medical Information .......................................................... 18

MyChart Inpatient: Day at a Glance ............................................................................................................. 18

Requesting Medical Records......................................................................................................................... 19

Opening Requested Records in MyChart ....................................................................................................... 19

Viewing Results in MyChart .......................................................................................................................... 21

Viewing Shared Notes .................................................................................................................................. 22

End-of-Life Planning ......................................................................................................................... 23

Update Health Care Agents .......................................................................................................................... 23

Upload Planning Documents ........................................................................................................................ 23

MyChart Secure Communication ...................................................................................................... 24

Messages in MyChart ................................................................................................................................... 24

Requesting Prescription Refills ..................................................................................................................... 25

Notification Medication is Ready for Pickup at UH Employee Pharmacy ........................................................ 26

Reporting a Flu Immunization as Complete ................................................................................................... 27

Page 3: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

3 | P a g e

Using MyChart Flowsheets ........................................................................................................................... 28

E-Visits ........................................................................................................................................................ 29

Referral Letters in MyChart .......................................................................................................................... 30

Management of Notification Settings ........................................................................................................... 30

MyChart Scheduling and Appointments ............................................................................................ 32

Requesting and Canceling Appointments ...................................................................................................... 32

Schedule a Prompt Care or Emergency Visit with On My Way ....................................................................... 35

Schedule Flu Shots with Direct Scheduling .................................................................................................... 35

Appointment Details: Wait List, Add to Calendar and Driving Directions ....................................................... 36

eCheck-In ..................................................................................................................................................... 37

MyChart Bill Pay .............................................................................................................................. 39

Set Up Paperless Billing ................................................................................................................................ 39

Making Payments with Online Bill Pay .......................................................................................................... 39

Set Up a Payment Plan with Online Bill Pay .................................................................................................. 40

Billing Account Summary – Account Details .................................................................................................. 41

Pay as Guest ................................................................................................................................................ 42

Add or Update your Insurance Coverage ....................................................................................................... 42

MyChart Mobile ............................................................................................................................... 44

Installing the MyChart Mobile App ............................................................................................................... 44

Feature Comparison: MyChart Web vs. Mobile ............................................................................................ 45

Proxy Access .................................................................................................................................... 47

Proxy Forms ..................................................................................................................................... 49

Page 4: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

4 | P a g e

MyChart General Information

What is MyChart

MyChart provides you with online access to your health information at University Health Care System and

participating providers. The free service allows you to take an active role in your healthcare and enjoy the

convenience of many online features. With an active University Health Care System MyChart account you can:

Request, Schedule or Cancel an appointment Receive notifications about Wait List appointment opportunities View test results Send secure messages to your providers Request an E-Visit for treatment of common symptoms from your home or office eCheck-In for your scheduled appointments from your home or office Review Allergies, Medications and Problem List Request and view medication renewals Pay your bill online (Must be the guarantor of the account) View your child’s or dependent’s medical information (authorization required) View, download and transmit your health summary Access preventative care information Download requested University Hospital medical records for no charge

Important Numbers and Information

University Health Care System MyChart Helpline (24/7) (706) 774-5800 University Hospital (706) 722-9011 University Hospital McDuffie (706) 595-1411 University Hospital Summerville (706) 481-7000 For billing inquiries: University Health Care System Patient Accounts, M-F 8:30AM to 5:00 PM

(706) 828-2333 or (800) 763-0250

University Health Care System Hospital Campus Locations:

University Hospital University Hospital McDuffie University Hospital Summerville 1350 Walton Way 2460 Washington Road 2260 Wrightsboro Road Augusta, GA 30901 Thompson, GA 30824 Augusta, GA 30904

University Health Care System Web Addresses:

www.uhmychart.org

www.universityhealth.org

Page 5: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

5 | P a g e

Using the UH MyChart Website

The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose

and focus for how you interact with your online record as well as user and site preferences.

Home Page: The MyChart home page is designed to provide notifications for alerts and allow quick access to commonly used

MyChart features.

Health: The Health tab contains the majority of clinical information available through MyChart. This section connects you

to your medical information where you can view test results, current health issues, medical history and provides

opportunity to request changes to allergies, medications and problems. You can also request appointments for

overdue preventive care procedures. The medical tools section contains links to requested copies of your medical

record. You can also create a printable wallet card summary of your medical information.

Visits: The visits tab contains links to future and past appointments. You can also request an appointment with a provider

you have an established relation with or find a new provider.

Messaging: The messaging tab contains links to MyChart’s communication tools. In this section you can view your sent and

received messages, compose a message to your care team, view letters, and review medications for refill requests.

Billing: In the billing tab are links to your University Health Care System accounts. In this section you can view your billing

account summaries or pay your University Health Care System and participating affiliates’ bill. You can also

request changes to your insurance and view your coverage details.

Resources: The resources tab contains useful links to University Health Care System events and MyChart feature videos. The

printable form to request a copy of your medical record is located on this page. The search medical library is a

comprehensive online compilation of the Krames Staywell health library. You can search this library of medical

health information for personal education and well-being.

Profile: Profile tab gives you access to change your demographics and security (password) settings. In this section you

may also change what alert types you receive and set preferences for scheduling. Linked Apps and Devices

displays a list of mobile devices you have the MyChart mobile app installed.

Page 6: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

6 | P a g e

1. Navigate your preferred browser

to www.uhmychart.org.

2. Click on “New User?”.

3. Complete the MyChart Self Sign-

Up form and click “Submit”.

4. After completing the “MyChart

Self Sign-Up” form and if you

have an established medical

record at University Health Care

System, you will be provided a

MyChart account immediately.

Instant activation from a mobile device

1. When you receive the instant activation text or email, click the “Use this link to sign up for MyChart now” link.

2. The MyChart Signup page will open where you can enter your Username, Password and verify the last 4 digits of your Social Security number.

3. Check the “I agree to the Terms and Conditions” and click Submit.

MyChart Account Creation and Profile

Instant Activation Registration, Billing and Clinical staff can send you an activation text or

email that contains a secure link to activate your MyChart account. The

activation link expires after 30 minutes. Clicking the link after it

expires will open a sign up page with an activation code where you will

need to provide additional information to activate your account.

Activate a MyChart Account via Internet

Page 7: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

7 | P a g e

Activate a MyChart Account via Mobile App Refer to the MyChart Mobile section of this guide for instructions on installing the mobile app.

Once the mobile app is installed, tap the Sign Up Now button to initiate the activation process.

MyChart Account Profile Change account settings and preferences while logged into MyChart web by going to the Profile tab on the

main menu. Use this section to make changes to your demographics, security, notification settings and

other preferences.

Preferences and Info:

Personalize: Change your account name and picture. Revoke proxy access to your account.

Notifications: Choose how you would like to receive MyChart notifications. For example, receive text messages and/or emails.

Personal Information: Change your mailing address, email address, contact information and personal details.

Other Preferences: Set your preferences for scheduling appointments.

Account Settings:

Security Settings: Change your password and security question/answer. Manage My Accounts: Manage MyChart accounts with other organizations. Linked Apps and Devices: Add or unlink trusted devices that you have MyChart mobile installed.

Page 8: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

8 | P a g e

Retrieving your MyChart Username and Password Reset

How to Retrieve your MyChart Username:

If you forget your MyChart username, use the Forgot Username link on the log in page to send an email with

your username. You will need to verify your first and last name, last 4 digits of your SSN and date of birth.

How to Reset your MyChart Password:

If you need to reset your MyChart password click on the Forgot Password link on the MyChart log in page. You

will need to verify your MyChart username, last 4 digits of your SSN and date of birth. You will then receive an

email with a link to reset your MyChart password.

Page 9: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

9 | P a g e

Sharing and Linking University Health Care System MyChart with other Organizations

Lucy and MyChart Central

Lucy is a personal health record providing a

permanent home to organize all your medical

information. Within Lucy, a patient can add or upload

external documents. You can also add personal

information about your health and choose to share it

with University Health Care System and our

Subscribing Providers, as well as other organizations

where you receive care. Lucy will follow you

wherever you go, even if your insurance or providers change.

MyChart Central groups together your University Health

Care System MyChart account with any other nationwide

MyChart account. Additionally, MyChart Central allows

you to utilize Lucy and maintain a single username and

password.

How do I sign up for Lucy and MyChart Central

1. Log on to your University Health Care System MyChart account.

2. Mouse over “Health” and click on “Lucy”.

Page 10: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

10| P a g e

3. To create a Lucy account, select yes when prompted. This is not required for a MyChart Central account, however it is necessary if you want to create a Lucy account later.

4. Click the “Link Me Up with Lucy and MyChart Central” button. See screen shot:

5. Click “Create New Account” to create a MyChartCentral account.

6. The next steps involve creating a user name and password, creating security questions, etc. NOTE:

If your UH MyChart User ID and Password meet the same requirements as MyChart Central, feel free to use the same ones!

7. After completing the required fields, you will receive an email to activate your new MyChart Central account.

Page 11: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

11| P a g e

8. Click on the link within the email to complete your MyChart Central account. Please note, as seen in the email, the link is only active for one day.

9. Enter your username and password.

Page 12: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

12| P a g e

Link My University Health Care System MyChart Account with Another Organization’s MyChart Account

Once you have a MyChart Central account, you can link to your MyChart accounts at other healthcare

organizations. Note: Creating a MyChart Central account automatically creates a Lucy account. We

will discuss how to access and use Lucy later in this user guide. The next two steps are to link your

University Health Care System MyChart account with another healthcare facility’s MyChart. For

example, Memorial Hospital in Savannah, GA offers MyChart. A patient could receive care from both

facilities, thus having two MyChart accounts.

1. While logged into your MyChart Central account, University Health Care System is defaulted as the organization to link to. Simply enter your MyChart password and click “Link This Chart”.

2. To link another healthcare organization’s MyChart account, click the “Add a New Healthcare Organization” button. Click the drop down arrow to select another organization and click “Link This Chart”.

Congratulations!!! You have created a MyChart

Central account and linked at least two

separate MyChart accounts to one log in. To

access both, simply log on to your University

Health Care System MyChart and choose the

Lucy and MyChart Central link.

Page 13: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

13| P a g e

Accessing Lucy

As mentioned earlier, creating a MyChart Central account automatically grants access to Lucy. Let’s learn

how to access Lucy, your portal for adding data to your Personal Health Record (PHR) and uploading

documents, as well as sharing with medical providers at University Health Care System and other

MyChart facilities. Examples of PHR are allergies, medications, medical conditions and other important

information about your health.

1. Log on to your University Health Care System MyChart account.

2. Go to the “Health” tab and click on “Lucy”:

3. Click on the Lucy link.

4. Presented are user friendly fields for you to add your allergies, medications, medical history etc.

Page 14: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

14| P a g e

5. To add or upload a document from your personal computer and save in your personal document library, click on the “Add a Document From My Computer” button and follow the prompts.

How to share my Lucy data with University Health Care System Providers and/or another facility

1. Click on the “What can my healthcare providers see” link within the Personal Health Record or Document section.

2. Click Share or Don’t Share. Any Private Notes entered will NOT be shared.

Page 15: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

15| P a g e

Additionally, you have the option to print or download your

Personal Health Record by selecting the Options link:

When will my care givers see my Person Health Record?

University Health Care System clinical staff can view your shared Personal Health Record and uploaded

documents when you are seen by an ambulatory provider, when admitted to the hospital or when you

receive care from our Prompt Care offices or are seen in the Emergency Room.

Share Your Record With MyChart web and mobile you can choose to allow an outside provider one-time access to your

health record. From MyChart web go to Health>Share My Record, type in a name for the person you are

sharing with and click Request Share Code.

In the MyChart Mobile app, click on the Share My Record icon to request a share code. Share the code to

the provider you wish to have access. The provider will go to https://shareeverywhere.epic.com to

enter the code plus your date of birth to access your record.

Page 16: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

16| P a g e

View, Download, and Send Visit Records Follow the steps below to view or download a visit record:

1. Navigate to Health>Document Center link.

2. Click the Visit Records link. You can filter visit records as a single visit, by date range, or all visits. If you wish to only view one record, select the visit you would like to view and click the View button. A pop-up window appears with the visit’s information displayed.

3. To download the record, click the

Download button. You may choose to protect the file with a password. It may take a few minutes for your request to process. When the visit record is finished downloading, you can open the saved ZIP file and double-click the embedded “My Health Summary” PDF file to view the visit information. Requested records are available for 30 days in the Health>Document Center Requested Records page.

Page 17: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

17| P a g e

Follow the steps below to send a visit record:

You can send your visit record to a doctor

outside University Health Care System by

searching or specifying a direct address or email

address.

1. Click the Send button. 2. Enter the provider’s information 3. You can optionally send to an Email

Address by clicking the “send to an email address” link.

Page 18: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

18| P a g e

Accessing University Health Care System Medical Information

MyChart Inpatient: Day at a Glance

Day at a Glance is a feature that allows MyChart users and their proxies to view a summary of scheduled

events during a hospital admission. Labs, consultations, procedures, medications, and imaging orders

will appear on the timeline. Clicking on an item will open a details page where you can view information

about a scheduled lab or medication. Day at a Glance also allows you to navigate to past and future

events. It is a default page that loads during an admission and can also be accessed via the Visits tab by

clicking the Day at a Glance link.

Page 19: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

19| P a g e

Requesting Medical Records

1. To request an electronic copy of your medical records go to the Resources Tab and click on “Useful Links”.

1. Click on the Medical Records Release of Information and Form for University Health Care System Hospitals and Practices link to download a copy of the form.

2. Print and complete the form and be sure to select you wish to receive the record via MyChart. 3. Instructions for submitting the form via FAX or standard mail are included. 4. Once the form is processed you will receive a notification that the record is available for download

on the University Hospital MyChart website.

Opening Requested Records in MyChart

1. Log into MyChart at www.uhmychart.org.

2. Navigate to the Health>Document Center link.

Page 20: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

20| P a g e

3. On the Document Center page, click the Requested Records link

4. Clicking the link will take you to the Requested Records page. From here you can click the Download button to either Open or Save the requested document. NOTE: It is recommended to choose the Save as… option as you can save a copy to your computer for future access.

Page 21: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

21| P a g e

Viewing Results in MyChart

When results are released to your MyChart account you can view them on the Test Results page. Follow

the steps below to view test results and other interactive tools available.

1. Navigate to Health>Test Results to open the Test Results page. This page contains links to all results released to your MyChart account.

2. Click on a test result to open the details page. You can view past results as well as graphed historical values by clicking the appropriate tab. Clicking the “About This Test” link will open a new browser window where you can read details about the test results and what the component values mean. If you wish to print a copy of your test results, click the printer icon.

Page 22: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

22| P a g e

Viewing Shared Notes

Some providers can share their progress note to your MyChart account. These include outpatient progress

notes and Emergency Department notes. To view your shared note go to Visits>Appointment and Visits page.

In the Past Visits section click on the appointment and the click on the Notes tab.

Page 23: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

23| P a g e

End-of-Life Planning End-of-life planning provides an opportunity for you to document your advance directives as well as upload

Update Health Care Agents

You or your proxy may update/add health care

agents in MyChart. A health care agent may

make medical decisions on your behalf in the

event you are unable to do so. To add a health

care agent, go to Health>End of Life Planning

and click “Add Health Care Agent”. You may also

specify a first or second alternate and upload any

formal legal agreement such as a Medical Power

of Attorney.

Upload Planning Documents

You may upload documents related to your end-

of-life planning. Typical documents that may be a

part of your plans include an Advance Directive

and Living Will, a Physician Order for Life-

Sustaining Treatment (POLST), and a Power of

Attorney for Health Care. Submitted documents

are only reviewed for legibility.

Page 24: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

24| P a g e

MyChart Secure Communication

Messages in MyChart

Message Center Inbox

Your Inbox contains messages received from University Health Care System and affiliate care providers

either as responses to your own inquiries or as notifications regarding your health care. NOTE: You will

not be able to delete unread messages. This is to ensure that any important messages are not

inadvertently deleted. Unread messages are indicated in bold letters.

Sent Messages

When viewing your messages in MyChart you can easily see which messages have been read by the

recipient by going to the Sent Messages link under the Messaging tab. Messages that have not been

read by the recipient are indicated with an icon and message as illustrated below:

Page 25: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

25| P a g e

Sending a Message (Ask a Question)

Sending a message to your care team is easy. When selecting Ask the Office from the Messaging tab you

have the option to ask a general medical question or open a symptom-specific E-Visit. A new medical

question would include Non-Urgent Medical Question, Prescription Question, Test Results Question, Visit

Follow-Up Question, and Referral Request.

Requesting Prescription Refills

Refill requests on eligible medications can be sent via MyChart secure messaging from the web or mobile

app. Use the following guide to request medication refills using your MyChart account.

1. From the Messaging>Request Rx Refill or Health>Medications tab, navigate to the Medications page.

2. Your complete medication list appears. If you have multiple medications to refill, click the Request Refills button. Otherwise, click the Request Refill button when your mouse is hovering over the medication.

3. Select the medication(s) you wish to refill and enter any comments. You may add comments for individual medications for the clinician to review.

Page 26: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

26| P a g e

4. Enter the pharmacy that you wish to pick your medication from as well as the pickup date and time then click Submit Request.

5. A notification is sent to the prescribing doctor with your request information. If there are no refills remaining then the doctor’s office will need to approve a renewal before the pharmacy can complete the refill.

Notification Medication is Ready for Pickup at UH Employee Pharmacy

This notification is only available when using the University Hospital Employee Pharmacy.

When a provider electronically prescribes or hand writes a medication to be filled at UH's Employee Retail Pharmacy, the MyChart patient can be notified when their prescription is ready for pickup. To ensure your MyChart account is set to notify you, log into MyChart and under the Preference tab, click on Notification and make sure you have selected the Prescription Ready notification. In addition, if you have valid refills, you can also request a refill through MyChart. Your request will go

directly to the pharmacy for processing. Once your prescription is ready, you will be notified the

medication is ready for pickup.

1. Upon logging into MyChart and if the medication was approved and sent to UH Employee Pharmacy, you will find a message stating: View details about your prescription which is ready for pick up.

2. Clicking the message link will take you to the Medications screen for more details.

Page 27: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

27| P a g e

Reporting a Flu Immunization as Complete

MyChart web and mobile users can document flu immunizations that are administered outside of

University Health Care System.

- From MyChart web go to the Health>Health Summary page and click on the Preventative Care tab. From there you can mark an overdue flu shot as complete and provide a completion date.

- On MyChart Mobile tap on the Health Reminders icon and select flu shot. When you tap on Mark as Complete you can enter the date. Tap Accept to mark the flu shot as complete.

Page 28: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

28| P a g e

Using MyChart Flowsheets

MyChart flowsheets allow you to track important health metrics and securely send that information back to your

provider. There are currently six flowsheets that your provider can order for you to track your health:

Blood Presssure Congestive Heart Failure Exercise Glucose Level Peak Flow Weight

If you are currently logging any of these items on your own and would like to be able to log them in your MyChart

account, you can ask your provider to order the flowsheet for you. When the flowsheet is ordered you will receive

a MyChart message containing a link to the Track My Health page (available under the Health tab). The example

below is how to add data to a Blood Pressure Flowsheet:

1. Log into MyChart and go to the My Medical Records tab to click on the Track My Health link.

2. The Track My Health Page lists all of your active flowsheets. Click on the flowsheet that you wish to log data.

3. Click the Add New Data button. Enter the Date, Time and your Systolic/Diastolic readings. You

can also add historical data by clicking on the icon and selecting the date. Click the Add Another Reading button to log additional readings. You can log up to 3 readings before submitting the data. When you are finished click the Continue button to review your readings.

4. Review your readings before clicking Submit to ensure the data is correct. When you click submit your readings are sent directly to your provider to review.

5. Once you submit the data, the flowsheet page will open where you can add more readings or review past values.

Page 29: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

29| P a g e

E-Visits

University Health Care System allows patients to request an E-visit in MyChart for treatment without

being seen in person. Currently, active MyChart patients can initiate an E-visit from their account for the

following health concerns: Back Pain, Diarrhea, Sinus Problems, Vaginal Discharge/Irritation, Cough, Red

Eye, Ear Pain, Rash, Sore Throat, and Urinary Problems. You may also start an E-Visit for someone you

have proxy access to. E-Visits are available from MyChart web and mobile. To initiate an E-visit from

MyChart web, follow this guideline:

1. Log into your MyChart account at www.uhmychart.org. 2. On the home page Quick Links sidebar, click the Schedule an Appointment link. Click the E-Visit

sidebar link on the Schedule an Appointment page. 3. Accept the Terms and Conditions. 4. Complete the required fields on the E-Visit Payments page and click “Authorize $35.00”. Note that

you will not be charged until staff have accepted and completed the E-Visit. 5. Confirm the information is correct and click “Submit Authorization” to proceed or “Back” if any

corrections need to be made. 6. Select a reason for E-Visit, E-Visit Provider, and Pharmacy on the Reason for E-Visit page. 7. Verify current Health Issues, Medications and Allergies (if any) 8. Answer questions regarding the complaint (These are dependent upon which type of reason for E-

Visit). 9. Review your information and submit E-Visit if no edits are necessary.

Page 30: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

30| P a g e

Referral Letters in MyChart

When the status of a referral authorization changes, you will receive a letter in your Messaging > Letters

inbox. If you have elected to receive email notifications an email will be sent to notify you that a letter is

available in your MyChart account. Otherwise, a notice on the MyChart home page will inform you of the

new letter.

The referral letter notification informs you when a referral status has changed, for instance, if the referral

is approved by your insurance provider. It also provides details regarding the referral such as the

diagnosis, authorization number, plus both referring and referred to provider information.

Management of Notification Settings

Notification management is easy using the Notification Settings page. This page is accessed via the

Profile>Notifications link. The page has separate sections for email, text, telephone and mail notifications

in order to focus on one delivery method at a time. On each tab, similar types of notifications are grouped

together under collapsible headers to make finding message types easier. You may also opt in or out of

entire groups of message types instead of having to select each individual message. Users with proxy

access can also apply changes to those accounts by clicking “Apply to all records I can access”.

Page 31: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

31| P a g e

Page 32: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

32| P a g e

MyChart Scheduling and Appointments

Requesting and Canceling Appointments

MyChart enables you to send an appointment request to providers with whom you have an established

relation. Problem Follow-Up Visit and Screening Mammogram allow you to choose an available date

based on the provider’s schedule. New Problem Visit, Well Child Check-Up, Well Adult Check-Up, and

Annual Physical allow you to submit a request for an appointment within a specified date range, list of

providers, and preferred times. The instructions below detail these two different scheduling options.

Scheduling a Problem Follow-Up Visit:

1. Log into your MyChart account, navigate to the Visits tab and click Schedule an Appointment.

2. Click on the Problem Follow-Up Visit link. 3. Choose a Location and a Provider with whom you

wish to schedule. 4. Choose a range of dates and a time you wish to be

seen. 5. Verify your appointment and optionally, provide additional details about the visit in the

Comments. 6. When you click Schedule It, a confirmation page opens with options to Reschedule, Confirm

Appointment and Pay Copay.

Page 33: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

33| P a g e

Saving a Problem Follow-Up Visit as a Favorite:

After scheduling a problem follow-up visit you have the option to save the appointment as a favorite to

easily reschedule the appointment in the future.

Submitting an Appointment Request:

1. Log into your MyChart account, navigate to the Visits tab and click Schedule an Appointment. 2. Click on the New Problem Visit link. 3. Choose a location and provider. 4. You may choose a preferred date range in which to schedule and enter any comments

regarding the visit. Click Send request when finished. A message is sent to the office you requested the appointment with which you can review in your Sent Messages outbox in Message Center.

Page 34: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

34| P a g e

To cancel or reschedule an appointment follow the steps below:

1. Log into your MyChart account and from the Visits tab, click on Appointments and Visits.

2. In the Upcoming Visits section, click on the appointment you wish to change to open the Appointment Details page.

3. Click on Cancel or Reschedule button as appropriate.

NOTE: You may cancel your appointment via MyChart up to 24 hours prior to your arrival time. You will need

to call the appointment office if you wish to cancel within 24 hours of your arrival time.

Page 35: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

35| P a g e

Schedule a Prompt Care or Emergency Visit with On My Way On My Way allows you to schedule an appointment via MyChart web and the MyChart Mobile app. Access

On My Way from the Schedule an Appointment page by clicking Schedule an Appointment from the

Quick Links sidebar. Then click on the On My Way link to open a page with a map overlay of University

Health Care System Prompt Care and Emergency Department locations. You can choose a location based

upon earliest appointment time or driving distance. Once you have chosen a location click the On My

Way button to schedule your appointment. Please ensure to include your phone number, current email

address and (optionally) a comment as to your reason for visit. On My Way also offers directions from

your mobile device with location services enabled or from a web browser.

Schedule Flu Shots with Direct Scheduling Between August and April you can use direct scheduling to make an appointment for flu shots at any Primary

Care location where you have an established relationship with a provider.

Page 36: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

36| P a g e

Appointment details view

An upcoming visit on the Appointments and Visits page

Appointment Details: Wait List, Add to Calendar and Driving Directions The Appointments and Visits page provides an overview of upcoming and past visits. On this page you

can also schedule an appointment and view details of an upcoming visit. If you are within 7 days of an

eligible appointment, you can initiate an eCheck-In by clicking Update Information. Clicking Details

provides other convenient options to prepare for your upcoming appointment.

Wait List is a feature allowing MyChart users the option to receive offers for an earlier appointment, if a

timeslot becomes available. When a slot becomes available and your name is on the Wait List, you will

receive notification of the earlier appointment. The Wait List offer expires in two days. Also, other

patients can receive the same offer for an earlier appointment; the slot will go to the first person to

accept. Your original appointment remains unchanged if you choose not to accept any Wait List offers.

You may add your appointment to a calendar application that supports the .ics file extension, i.e.

Microsoft Outlook, Google Calendar and Apple Calendar. Simply click Add to Calendar to download and

open the file.

Get Directions uses location services in your web browser or mobile phone to provide directions to the

appointment location.

Page 37: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

37| P a g e

eCheck-In eCheck-In through MyChart allows you to verify your medications, allergies, health issues, travel history,

insurance information, as well as make payments prior to arriving for your appointment. The eCheck-In

process is available for eligible appointments that are within a 7 day time frame and can be submitted up

to 10 minutes prior to your appointment. To initiate eCheck-In click on the Update Information link on

the upcoming visit or Appointment Details page.

Complete an eCheck-In

Initiate the eCheck-In process by clicking the

Update Information button. The banner at the

top will track your progress.

1. Verify your personal information. (NOTE: At anytime during the eCheck-In process you may click “Finish Later” to pause your eCheck-In progress. Returning to complete the eCheck-In at a later time will begin where the process was left off so you will not be required to start over from the beginning.)

2. On the Insurance page verify your coverage and choose whether or not you wish to bill your insurance for the visit. You may also request an update to your coverage and add insurance card photos.

Page 38: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

38| P a g e

3. On the Payments page you may elect to pay any copays or outstanding balances. This step will not appear for affiliate offices who do not participate in online billing.

4. Enter your credit card information to pre-approve your copay. You may also elect to pay at the office. If you only elect to pay your copay then the card will not be charged until you arrive at the clinic. However, if you elect to also pay any outstanding balances your card will be charged immediately.

5. Verify your medications on file. You may also request to add a medication by clicking the + Add a Medication. You may also select or add a preferred pharmacy.

6. Review allergies. You can request to add an allergy by clicking the + button. 7. Review Health Issues. You can request to remove and add any health issue by clicking the respective

remove button or clicking the Add Health Issue button. 8. Document any trips outside the country on the Travel history section. 9. Complete any questionnaires associated with your visit that may present. 10. eCheck-In Complete. You can view information about your appointment after completing the eCheck-

In process. If you have elected to pay your copay by credit card during the eCheck-In process, a notification will be sent to you by email that you can view the details of the transaction in your MyChart inbox.

Page 39: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

39| P a g e

MyChart Bill Pay Bill Pay through MyChart allows you to pay your University Health Care System bill online. Furthermore,

some of our affiliate practices have opted to participate in online billing and those practices will appear in

your billing account summary page with an option to pay your bill. You also have an option to enroll in

Auto Pay which allows you to make scheduled monthly payments on an account balance using a credit

card.

Paperless billing allows MyChart users to save paper by viewing their University Health Care System bills

online. Paperless billing can be started and stopped at any time.

Set Up Paperless Billing

1. In MyChart navigate to the Billing>Account Summary page and click the Sign up for paperless billing link.

2. Should you at any time change your mind, simply return to the site and turn off the Paperless Billing feature.

Making Payments with Online Bill Pay

1. To access the Billing Account Summary page go to the Billing tab and click the Account Summary link.

2. The Billing Account Summary screen displays a full listing of all of your accounts with University Health Care System and affiliate practices.

3. You have the option to pay on any balance for University Health Care System and affiliate practices. Note: Not all affiliates participate in online bill pay.

4. If the Pay Now button is available next to the account, then you are able to make a payment on that account via MyChart Bill Pay.

5. Click Pay Now to make a payment.

Page 40: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

40| P a g e

6. You have the option to pay the total amount due or to specify an amount.

7. After completing the payment form, a validation screen appears to confirm your information. If no changes are needed, click Submit.

8. You will see a confirmation screen, provided your payment processed successfully. If you receive one of the following errors, contact your credit card company.

Decline Type:carderror Decline Type:avs Decline Type:fraud

Decline Type:call Decline Type:cvv Decline Type:decline

Decline Type:expiredcard

Set Up a Payment Plan with Online Bill Pay

MyChart online bill pay allows you to schedule a monthly payment on a portion of your balance using a

credit card. You will receive a confirmation email each month your card is charged.

1. Navigate to the Billing Account Summary page and click the Set Up Payment Plan button on the account.

2. A minimum amount based on your balance will automatically be calculated for you but you have an option to increase the monthly amount.

Page 41: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

41| P a g e

View of the visit charges in the Account Details

View with Auto Pay feature enabled

3. Clicking Next will open a payment information page where you will enter your card information.

4. Once the payment plan is set up your account updates to indicate the Auto Pay feature with the next scheduled payment date and amount.

Billing Account Summary – Account Details

Viewing Account Details

On the Billing Account Summary page find the account and click View account details. The Account Details page includes your current balance summary, guarantor demographics, account details (with itemized charges and CPT charge codes) and statements. Note: Only accounts that you are listed as the guarantor for will appear on this page. On the Account Details page you can see all services billed in addition to any payments and/or adjustments that are matched to them. Also notice that CPT codes are listed for any charges posted during a visit:

Page 42: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

42| P a g e

Pay as Guest payment screen

Pay as Guest

Accessing Pay as Guest from the MyChart log in page, allows you to make payments using a credit card

without needing to log into MyChart. Advanced billing features such as payment plans are not available with

Pay as Guest. To use Pay as Guest you will need your guarantor account number to access the account

information. You may also receive email notifications when a new statement is ready. The email will contain

a link to Pay as Guest that will auto-fill your guarantor account number.

Add or Update your Insurance Coverage

Update Coverage:

From the Billing>Insurance Summary page you can send a

request to add or update your insurance. Click on

“Update coverage” to submit a comment detailing

changes to your coverage. You may also add insurance

card photos. Submitted requests will appear in the

Pending Review section.

Page 43: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

43| P a g e

Add a Coverage:

Click the “Add A Coverage” link to submit information

about a new coverage you would like to add. You may

be asked to provide the insurance type, member

number, group number and whether or not you are

the policy holder. The option to upload a copy of your

insurance card is also available.

Page 44: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

44| P a g e

MyChart Mobile

Installing the MyChart Mobile App MyChart Mobile provides a convenient way to access many of the

features available on MyChart web. Both Android and iPhone

platforms are supported. Simply search for MyChart at your

respective platform’s store and tap the install button. After the

app has installed:

1. Open the app and when prompted for “Select Healthcare Provider”, choose either Georgia or South Carolina.

2. Scroll down the list until you see University Health Care System and the University Health Care System (UHMyChart) logo.

3. Once you have selected University Health Care System as your provider, you can log in with the same username and password used when activating your account via MyChart web.

Page 45: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

45| P a g e

Feature Comparison: MyChart Web vs. Mobile

The MyChart mobile app is available for both Android and iPhone. It offers many of the same features as

the web based MyChart site on your mobile device. The table below compares what features are

available for the web-based MyChart and MyChart Mobile.

Patient Access MyChart Web MyChart Mobile Proxy Access Yes Yes Messaging Inbox Yes Yes Get Medical Advice Yes Yes Request Rx Refill Yes Yes Letters Yes Yes Request a Referral Yes No Sent Messages Yes Yes Visits – Scheduling and Appointments Upcoming Appointments – Listing and Detail Yes Yes Past Appointments – Listing and Detail Yes Yes Past Admissions – Listing and Detail Yes No Cancel Appointment Yes Yes Schedule an Appointment Yes Yes View Download and Transmit Visit Information

Yes No

On My Way Yes Yes Request an E-Visit Yes Yes Upcoming Tests and Procedures Yes No eCheck-In Yes Yes Fast Pass Appointment Offers Yes Yes Wait List Updates Yes Yes Open Scheduling Yes Yes Health and Clinical Features Plan of Care Yes Partial Test Results Yes Yes Care Everywhere Authorization Yes No Health Summary Yes Yes Current Health Issues Yes Yes Medications Yes Yes Allergies Yes Yes Preventive Care Yes Yes Immunizations Yes Yes Download My Record Yes No Growth Charts Yes No Requested Records Yes No Who’s Accessed My Record Yes No Care Everywhere Authorization Yes No Health Trends Yes No Questionnaires Yes Yes Patient-Entered Flowsheets Yes Yes End-of-Life Planning Yes No

Page 46: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

46| P a g e

Billing and Insurance Billing Account Summary Yes Yes Bill Payment Yes Yes Paperless Billing Yes Yes Coverage Details Yes No Insurance Summary/Plan Details Yes Partial Payment Plans Yes Yes Statements Yes Yes Proxy Access for Billing Features Yes No Billing Customer Service Messages Yes No Preferences and Administrative Features Personalize MyChart (Proxy Colors, Patient Photos)

Yes Yes

Demographics Yes No Change Password or Security Question Yes Partial Notifications Yes Yes Other Preferences Yes No Manage My Accounts Yes Partial Search the Health Library Yes No Other Mobile Features Passcode/Fingerprint Login No Yes

Mobile Email Notifications

MyChart Mobile’s email (push) notifications keep you informed of important activity in your account as

well as accounts you have proxy access to. With the MyChart Mobile app installed you can receive

notifications for the following items:

New Message New Test Result Wait List and Fast Pass Offers New Billing Statements Payment Reminders

These notifications are enabled by default when installing the

MyChart mobile app. To disable this feature while logged into the

mobile app:

1. Tap the menu (3 dots) in the upper right corner of the app screen.

2. Select Account Settings. 3. Turn Push Notifications to the off position to disable.

Page 47: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

47| P a g e

Proxy Access What is a Proxy?

Having Proxy access means someone has permission to view another person's MyChart information. Proxy relationships must be established by completing a University Health Care System MyChart Proxy Form.

Common Reasons to have Proxy Access

Parent accessing child:

A parent views her child's information in MyChart. Because children often cannot have their own MyChart account, providing parents with proxy access to a child's chart might be the only way to offer MyChart as part of a child's care.

Adult accessing adult:

One adult accesses the information of another adult patient. This is commonly used for a husband or wife to access a spouse's account or for an adult to access an aging parent's MyChart account to help manage the parent's care.

Example 1: A 15 year old child is seen at a place of service that supports MyChart. In order for a

parent or legal guardian to view the child’s information on MyChart, the parent or guardian would

complete the Adult to Child Proxy form and submit the form to the University Hospital Health

Information Department.

Example 2: A Grandmother is seen at a place of service that supports MyChart . She states she

does not have a computer and does not know how to use a computer. However, her daughter, who

is her care giver, has a smartphone and would like to be able to see Grandmother’s lab results,

request medication refills, ask questions or schedule an appointment. The daughter would submit

an Adult to Adult proxy form to University Hospital Health Information Department. If the patient

is unable to sign the consent, then the proxy (daughter) also needs to provide a copy of legal

documentation authorizing her to access the patient’s medical information.

Where is the Proxy form and how do I submit?

The Proxy forms can be found on the www.uhmychart.org page by clicking on the appropriate form type, i.e. “Adult to Adult” or “Adult to Child”:

Page 48: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

48| P a g e

(The proxy forms can also be found in this MyChart user guide.)

The form includes completion instructions and fax number to send to our Health Information Department/Medical Records at 706-774-8631. The Health Information Department will link the patient’s MyChart account with the Proxy’s MyChart account and notify the Proxy of their approved Proxy access.

How does the Proxy use MyChart to communicate with their physician’s office?

After the Proxy has completed the approved MyChart Proxy form and the Health Information Department has linked the two accounts, the approved Proxy can then begin accessing and communicating with the patient’s physicians. The Proxy should log into their own MyChart account and click on the patient’s icon, located on the top left of the screen. See the below example of Jake who has access to two other family members. Once in the other patient account, a proxy can access the same features as they would in their own account.

Page 49: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

49| P a g e

Proxy Forms The University Health Care System proxy forms are available on the next two pages. To request proxy

access to another person, please print the appropriate form and submit the completed form to Health

Information Department.

Page 50: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

50| P a g e

MyChart Adult Proxy Form Access to an Adult’s MyChart Record To request access to the MyChart record of an adult whose medical care you help manage, please complete this form.** The patient’s MyChart record will be accessed through your

MyChart record. If you do not have access to MyChart an activation letter will be sent to your home address. You will then need to activate your account in order to view the

MyChart record as a proxy.

To The Proxy/Agent* MyChart Terms and Agreement I understand that MyChart is intended as a secure online source of confidential medical information.

I understand that it is my responsibility to select a confidential password.

I understand that MyChart contains selected, limited medical information from the medical record and that MyChart does not reflect the complete contents of the

medical record. I also understand that a complete copy of my medical record may be requested from the provider of care.

I understand that my activities within MyChart may be tracked by computer audit and that entries I make may become part of the medical record.

I understand that access to MyChart is provided by University Hospital and Subscribing Providers as a convenience to its patients and that University Hospital and

Subscribing Providers have the right to deactivate access to MyChart at any time for any reason.

I understand that use of MyChart is a voluntary, optional service and that patients are not required to use MyChart.

Patient’s Information (All sections required – please print clearly)

Complete this section with information about the patient for whose MyChart record you are requesting/granting access:

First, Middle Initial, Last Name ____________________________________________________________________Date of Birth______________________________

SSN# _______________________________________________ Email__________________________________________________________________________________

Street Address______________________________________________________________________________________________________________

City_______________________________________________________State___________ Zip_______________

Phone Number:__________________________________

To The Person Granting Access

Patient hereby agrees to the following:

I authorize release of any information (including any protected health information) contained in my MyChart medical record maintained by University Hospital and

Subscribing Providers to the person named below as my MyChart proxy.

I understand that MyChart contains selected, limited medical information from a patient’s medical record and that MyChart does not reflect the complete contents of the

medical record. MyChart may include medical information relating to diagnosis of mental illness, alcohol/drug abuse, sexually transmitted diseases, HIV, some

communicable diseases, prevention of pregnancy, pregnancy and childbirth. MyChart does not include physician notes. MyChart may include prescription medications

and reasons for provider visits, past and future. I understand that it is not technically possible at this time to grant MyChart access that would not include these

categories of information.

This release is valid for information only through the MyChart record. This form does not authorize release of my medical record to my designated proxy by other

methods or in other forms.

I understand that once information has been disclosed, it potentially may be re-disclosed by the proxy and the disclosed information may not be covered by federal

privacy protections. I acknowledge that University Hospital and the Subscribing Providers have no responsibility for any such re-disclosure.

I may revoke this authorization at any time online pursuant to instructions at www.uhmychart.org or by providing a written request for revocation to the MyChart

Administrator. I understand that if I revoke this authorization, my designated proxy’s access to MyChart will be ended. I also understand my revocation will not affect

any disclosures that were made prior to processing this revocation request.

By signing below, I acknowledge that I have read and understand this MyChart Adult Proxy Form and the terms and conditions on the MyChart website at

www.uhmychart.org and agree to its terms. I understand that this authorization is voluntary. I am confirming my authorization that the health care provider may communicate and disclose to the person named in

this form the protected health information displayed in MyChart. ____________________________________________________ ____________________________________________ Signature of Patient or Authorized Person* Date

_______________________________________________________ ____________________ ___________________________

Name of person given access to information using MyChart (proxy) Date of Birth SSN #

__________________________________________________ _______________________ ________________________________________________

Street Address City, State, Zip Code Signature of Proxy Being Given Access

Your Relationship To Patient Listed Above:_______________________________________________________________________________________

Reference to “I” or “my” are “patient” perspective if executed by an agent or guardian, who is also bound by the terms. This shall mean an agent under a power of

attorney granting the authority to consent to disclosures of protected health information; Parent or Guardian of a minor; or Court Appointed Guardian. ** Copy of the

appropriate legal document is required.

Fax completed form to the Health Information Department at 706-774-8631. You will be sent your MyChart activation code by email or mail. NOTE: If received with incomplete or illegible information, it cannot be processed. One attempt to contact you by phone will be made. Revised 9/8/16

Page 51: University Health Care System - MyChart Patient...The University Health Care System MyChart website is divided into multiple sections. Each has its own purpose Each has its own purpose

51| P a g e

MyChart Child Proxy Form

Access to a Child’s MyChart Record

To request access to the MyChart record of a child whose medical care you help manage, please complete this form.** The patient’s MyChart record will be

accessed through your MyChart record. If you do not have access to MyChart an activation letter will be sent to your home address. You will then need to

activate your account in order to view the MyChart record as a proxy.

To the Proxy/Agent* MyChart Terms and Agreement I understand that MyChart is intended as a secure online source of confidential medical information.

I understand that it is my responsibility to select a confidential password.

I understand that MyChart contains selected, limited medical information from the medical record and that MyChart does not reflect the complete

contents of the medical record. I also understand that a complete copy of the medical record may be requested from the provider of care.

I understand that my activities within MyChart may be tracked by computer audit and that entries I make may become part of the medical record.

I understand that access to MyChart is provided by University Hospital and Subscribing Providers as a convenience to its patients and that

University Hospital and Subscribing Providers have the right to deactivate access to MyChart at any time for any reason.

I understand that certain information concerning treatment and requests for treatment by children are protected by state and federal statutes and

upon assertion of these rights by a child, parental access to MyChart will be terminated.

I understand that use of MyChart is a voluntary, optional service and that patients are not required to use MyChart.

By signing below, I acknowledge that I have read and understand this MyChart Child Proxy Form and the terms and conditions on the MyChart

website at www.uhmychart.org and agree to its terms.

Parent/Guardian Information (All sections required – please print clearly)

Complete this section with information about the parent/guardian who is requesting proxy access.

First, Middle Initial and Last Name___________________________________________________________________________________

Date of Birth____________________SSN# ______________________________________ Email________________________________________________________________________________

Street Address______________________________________________________________________________________________________________

City_______________________________________________________State_______ Zip_______________

Phone Number:____________________________

_______________________________________________________/____________________________________________/___________

Signature of Parent/Guardian (Required) Relationship to Child Date

Once your child reaches age 18, you will no longer have access to your child’s MyChart record through this form.

Please provide the following information for your child: (All fields are required). If you would like proxy access for another child, you can print a form

from our web page at www.uhmychart.org.

First, Middle Initial and Last Name __________________________________________________________________________________________________ SSN #______________________________________________________________ Date of Birth_________________________________________________

Primary Care Physician____________________________________________________________________________________________________________

*Reference to “I” or “my” are “patient” perspective if executed by an agent or guardian, who is also bound by the terms. This shall mean an agent under a

power of attorney granting the authority to consent to disclosures of protected health information; Parent or Guardian of a minor; or a Court Appointed

Guardian. ** Copy of the appropriate legal document is required.

Fax completed form to the Health Information Department at 706-774-8631. You will be sent your MyChart activation code by

email or mail. NOTE: If received with incomplete or illegible information, it cannot be processed. One attempt to contact you by phone will be made.