Adolescent Access Authorization Form

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MyHealth Online - Adolescent Access
Adolescent access for MyHealth Online allows an adolescent patient between the ages of 13 to 18 to view
components of their medical record and communicate with their physician's office regarding non-urgent
matters. The parent or legal guardian will also be able to view a limited portion of the adolescent's medical
record and communicate with the physician's office. In order to obtain access, Adolescent patients may sign up
for access only during an office visit. Parents who do not already have proxy access will need to sign the form
at the office.
Adolescent proxy access is terminated when the parent/legal guardian makes a written or online request to
terminate access. At age 18 the patient will have full control of their MyHealth Online account and the
parent/legal guardian access will be discontinued. Beyond the age of 18 the patient may still grant parent/legal
guardian access by requesting Adult Proxy access.
Adolescent Access and Adolescent Proxy Terms and Conditions:
The parent/legal guardian must complete and sign the attached Adolescent Proxy Authorization
Form. Please call the number listed on the Atrius Health Practice Location Information Sheet if you
need further assistance.
Important: You can print and fill-out this form at home but it will only be accepted if delivered to our
office in person.
Each parent/legal guardian requesting access must have an active MyHealth Online account but,
does not need to be an Atrius Health patient.
Adolescent access can be terminated by the parent/legal guardian at anytime online or by written
request.
For existing Pediatric Proxy MyHealth accounts, the parent/legal guardians access will remain in
MyHealth when the child turns 13, but the access will be limited as below.
MyHealth Access will enable you to:
Adolescents:
Parents / Legal Guardians:
View growth charts, immunizations, allergies
View growth charts, immunizations and
and medications
allergies
Communicate with your physician’s office on
Communicate with the physician’s office on
non-urgent issues
non-urgent issues
View lab results
View lab results
Request, schedule, cancel appointments
Schedule appointments (but cannot cancel or
review past/future appointments)
View appointment history
View School/Camp forms and letters
Additional features may be enabled over time
Additional features may be enabled over time
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