This document is a request and authorization form for proxy access to the MyChart at NYU Langone medical records of an adult. It outlines the requirements and procedures for granting proxy access, including the need for both the proxy and the patient or their legal representative to sign the form. The form also includes terms and conditions for using MyChart at NYU Langone, such as maintaining password confidentiality and understanding that the platform is not for emergency use. The document is incomplete, with missing signatures and patient information.
documents/EFTA00313923.pdf
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