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MyChart Access Forms



Activation Code Request for Myself

If you are 18 years or older, please go to the Sign up for your MyChart Account page. You will be able to sign up directly for MyChart after answering a few questions to verify your identity.

Activation Code Request for Others - Proxy Access


What is proxy access?

Proxy access allows a person to access data in another person's medical record. Typically, parents will use this to access their children's accounts so they can schedule appointments check immunizations, reorder medications, and coordinate other health-related information for their children. Adults may also use it to access an older parent or relative's record. This is particularly useful for helping older adults monitor medications and appointments. This communication is done using a HMH MyChart account and is restricted to non-urgent matters. Proxy access is granted once an authorization form has been completed and processed.


Submit Proxy Request Forms:

Download the appropriate form and mail it to Hackensack University Medical Center, Health Information Department, 30 Prospect Avenue, Hackensack, NJ 07601 OR Fax: 201-489-0591.


Access to Children's Records

Access to MyChart accounts for patients under the age of 18 requires a signed Proxy Access form. For children under the age of 12, the parent or guardian will receive full access to the account upon completion of the form. The child's physician's office can grant access after the form is completed. For parents or guardians for patients 12-17, access can be granted by the physician's office once the teen, physician and parent/guardian complete and sign the form. Proxy access is automatically terminated on the 18th birthday. The teen can create their own account at that time.


Adult-Adult Proxy

Adult-Adult proxy access allows another adult full access to the HMH MyChart account of a Hackensack Meridian Health patient who is 18 years of age or older. In order to obtain access, both the patient and proxy must complete and sign the HMH MyChart Adult Proxy Form. The proxy's access is terminated when the patient makes a written request to terminate access or revokes access from within their MyChart account.


To access the patient's chart


1. Log in to your MyChart account from our secure web page with your MyChart username and password.

2. Select the tab on the right with the patient's name.

Please feel free to contact us if you have any problems at MyChart Support.

Thank you for your interest!

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