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When the clinic receives your form, you will be mailed your access code. If your child is between the ages of 13-17 you will be granted partial access to his or her record.These age ranges comply with the state regulations, MN.



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Access to your health information in My Chart is secured by your personalized ID and password, known only to you. You may sign up for My Chart by completing an authorization form at your next clinic visit. Sign and return the form by mail or by dropping it off at the clinic.

If you have any questions about filling out the form contact your clinic’s My Chart representative. You are granted full authority by proxy to access your child’s medical chart if your child is between the ages of 0-12.

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