To access someone's medical record, something called a proxy access request form must be completed.
We have four different types of proxy access request forms. The type, and the qualifications for each, are listed below. All our proxy forms can be submitted online. Please note, you'll need a One Chart | Patient account of your own to complete these forms online. You can sign up for One Chart | Patient here.
If you prefer, you can also download a PDF of the form and mail or fax it in. The address and fax number are listed on the PDF downloads.
It may take up to four business days to process your request.
Teens: Authorize your teen to have their own One Chart | Patient account
If you are the legal parent or guardian of a teen (a child aged 13 to 18), submit this form to allow your teen to have their own One Chart | Patient account.
Children: Request access to a child’s One Chart | Patient account
If you are the legal parent or guardian of a child (anyone age 18 or younger), submit this form to access your child's One Chart | Patient account.
Adults: Request access to an adult’s One Chart | Patient account
Spouses, children or other family members
Submit this form to access a parent’s, spouse’s or other adult’s One Chart | Patient account.
Please note: You can grant someone else access to your own One Chart | Patient account through the Share My Record option without submitting this form, as long as the other person also has their own One Chart | Patient account. Simply log in to One Chart | Patient, select “Your Menu” in the desktop portal, or “More” in the Nebraska Medicine app. Select “Share My Record” from the list and follow the prompts.
Legal guardian or health care agent proxy
Submit this form if you are the legal guardian of an adult patient, a personal representative for an adult with legal authority to make health care decisions on behalf of an incapacitated adult.
How to see who currently has access to a One Chart | Patient account
Within the One Chart | Patient desktop portal
- Step 1: Log in to One Chart | Patient
- Step 2: Select “Your Menu” in the upper left corner
- Step 3: Scroll down until you find “Personalize” in the Account Settings section of the menu. Select “Personalize.” The records you can view, and the people who can view your records, are listed on this page.
Within the Nebraska Medicine mobile app
- Step 1: Log in to the Nebraska Medicine app
- Step 2: Select “More” in the lower right corner
- Step 3: Scroll down until you find “Friends and Family Access” in the Communication section of the menu. Select “Friends and Family Access.” The people who can view your record are listed on this page.