MyHealthONE Proxy Forms

To allow someone else to view the information in your MyHealthONE account you will need to set up caregiver access (formerly known as proxy access).

The caregiver access feature of MyHealthONE permits patients to grant access to others to view their MyHealthONE account, essentially linking the accounts together.

To be a Caregiver:

• Must be at least 18 years old
• Have an active email address
• Present Photo identification
• Should be a trusted individual

Steps to Assign Caregiver Access for your MyHealthONE Account

• Print the age appropriate proxy express waiver from the list below - do not complete
• Take the proxy express waiver with you to the hospital or urgent care clinic
• Read the age appropriate information below for direction on who has to be present   
• At registration you will be directed to a representative who will watch you complete and sign the proxy express waiver
• Upon completion of the Caregiver form please call the MyHealthONE support team at 1-855-422-6625 to complete the caregiver enrollment process

For Patients aged 0-12

Proxy Express Waiver - English

Renuncia Express Proxy - Español

• A parent or legal guardian must complete the Proxy Express Waiver and present photo identification
• Access expires on the patient’s 13th birthday

For Patients aged 13-17

Proxy Express Waiver - English

Renuncia Express Proxy - Español

• Select a trusted individual as your caregiver
• A parent or legal guardian and the minor patient must both be present and sign the Proxy Express Waiver
• Both parent/legal guardian and the minor patient must present photo identification at the hospital’s registration desk
• Access expires on the patient’s 18th birthday

For Adult Patients

Proxy Express Waiver - English

Renuncia Express Proxy - Español

• The patient will need to present photo identification at the hospital and be ready to provide information (name and email address) about their caregiver or proxy
• If the patient is unable to sign the Proxy Express Waiver, the patient’s Power of Attorney may take the Proxy Express Waiver to the hospital and sign on behalf of the patient. The Power of Attorney must present documentation and state-issued photo identification
• If the patient is unable to sign the Proxy Express Waiver but no Power of Attorney exists for the patient, then the caregiver or proxy enrollment cannot occur