CCSI MyChart - Login Page

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Request Access to a Child's Record

Please note the following age range limitations for MyChart. These age range limitations do not affect any legal right you have to access your child’s record by other means. To request a paper copy of your child’s record, please contact the facility where care was provided. Only parents and legal guardians can request access to a child’s record.

Access to a child under 12 years old: Print out the form and return it to your provider's office.

Access to a child 12-17 years old: Access for a child age 12-17 must be requested directly through your provider's office. A form can be completed in person or by phone with the patient and parent/legal guardian.

Please note the following limitations that may impact your access to MyChart:

- If your child is age 0-11: You will be granted full access to your child’s MyChart account.
- If your child is 12-17: Due to federal and state laws, when a child reaches the age of 12, access to their MyChart account will become limited to parents/legal guardians. A MyChart Child 12-17 Authorization form must be requested directly through your provider's office. Limited access will only include access to allergies and immunizations on file.
- If legal decisions, rulings, or judgements related to parental rights have been made that may impact MyChart access, additional information may be required.
- If we are unable to validate your relationship to the child (within either age range), you may be asked to provide a copy of their birth certificate.
- Once your child turns 18: Proxy access is discontinued. Review the information below for help accessing an adult account through MyChart.

Manage Adult Access

Sign in to CCSI MyChart and use the Friends and Family Access page to instantly:
- Grant another adult access to your record
- Revoke another adult's access to your record
- Revoke your access to another adult's record

If a patient is incapacitated, unable to communicate, make decisions, or sign, please provide copies of relevant legal documents (Guardianship, Power of Attorney, etc.). Click HERE for a printable copy. To request access, submit a completed form to the patient's provider office or hospital.

You can revoke your access to another record or another adult's access to your record from within your own MyChart account. You can also revoke access by printing out this form and returning it to your provider's office.