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MyChart - Proxy Access Form - Baptist Health

mychart.baptisthealth.com

The undersigned grants proxy access to his/her Baptist Health MyChart record to the person requesting proxy access listed above. Or, for a minor patient or incompetent patient, the undersigned grants proxy access to the patient’s Baptist Health MyChart record on behalf of the patient to the person requesting proxy access listed above.

  Form, Access, Proxy, Proxy access, Proxy access form

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