Adult MyChart at NItt. Lantone Proxy Access Request and Authorization Fenn Requirements and Procedures • Proxy access to the MyChan at NYU Langone record of an adult may be granted by the patient or his/her legal representative. • Both the person requesting access and the patie

gone contains selected, limited medical information from a patient's medical record and is not the complete medical record. • My activities within MyChan at NYU Langone may be tracked by computer audit and entries I make may become pan of the medical record. • Access to MyChart at NYU Langone is prov

S!Int EFTA00304453 Adult SIsChart at Ni 1. Langone Prtiss terns Rennes; and tuthurrration Form Requirements and Procedures • Proxy access to the MyChan at NYU Langone record of an ink* may be granted by the patient or his her legal representative. • Roth the paints requesting access and the patien

s to the medical incarnation available on MyChart at NYU Langone for the patient named below and agree to abide by the above teats and conditions of MyChan at NYU Langone and all other tans and condition viewable online within MyChan at NYU Langone. cpsert Nam: "Tap; Reic Dale or Binh: /*- 0 -53_ Em