Read information about electronic health records (EHRs) from the U.S. ![]() Central Rd, Arlington Heights, IL 60005Ĭoncerned about the privacy or confidentiality of your health information? Mail it to the Medical Records (HIM) Department, 800 W.Fax the form to Medical Records (HIM) Department at 84.Email the completed form to Submit it to the front desk staff of NCH Medical Group provider office.If you are printing a form, you can submit it one of four ways once the appropriate form is filled out and signed: M圜hart Minor Proxy Request – Grants access to a minor (0-17) account for a parent/guardian.Via M圜hart: Parent or legal guardian (with appropriate paperwork on file) can log into M圜hart and submit a request using the Request Minor Proxy Access option.M圜hart Adult Proxy Request – Grants access from one adult to another adult.You may also print and complete this form and follow instructions below to submit the form:.Via M圜hart: Patients can send a Proxy Invitation using the Share My Record > Friends and family access option. I understand that: My access to the patient’s medical records through M圜hart will be permitted only as long as I continue to serve as the patient’s. ![]() ![]() Do you want to give your family members access to your NCH M圜hart Account? Proxy access can be requested the following ways:
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