How to request proxy access
To access someone's medical record, you will need to complete a proxy access request form. There are four types of proxy access request forms. The type and qualifications for each are listed below. Please complete the form that matches your situation.
How to submit your form:
All proxy forms can be submitted online using the links below. To complete forms online, you'll need your own One Chart | Patient account. Sign up here.
You can also download a PDF version and submit it by mail or fax. The address and fax number are listed on the form.
Please note: Requests may take up to four business days to process.
Teens: Authorize your teen to have their own account
If you are the legal parent or guardian of a teen (ages 13-18), submit this form to allow your teen to have their own One Chart | Patient account.
Children: Request access to a child’s account
If you are the legal parent or guardian of a child (age 18 or younger), submit this form to access your child's One Chart | Patient account.
Adults: Grant someone access to your own account
If you want to grant access to your One Chart | Patient account to a spouse, parent, child or other family member, please submit this form.
Please note: You can also grant access without submitting a form by using the Share My Record feature.
- Log in to One Chart | Patient.
- Select “Your Menu” (on desktop) or “More” (in the Nebraska Medicine app).
- Choose “Share My Record” from the list and follow the prompts. Both parties must have their own One Chart | Patient accounts.
Legal guardian or health care agent proxy
Submit this form if you are the legal guardian of an adult patient or a personal representative with legal authority to make health care decisions on behalf of an incapacitated adult.
Frequently asked questions
Get answers to common questions about One Chart and the Nebraska Medicine app.