MyChart - Request to Access a Minor's Record

Thank you for your interest in ESNEFT MyChart, an easy-to-use internet tool that provides you quick and secure online access to some of your child's health information. To sign up for access to your child's ESNEFT MyChart record, please complete and submit the following form for approval. Once your request has been approved, we will email your activation code within 30 days. We will contact you if we have any questions regarding your information. Please note that access to a child’s record through MyChart can only be granted to a Parent or Legal Guardian.

Please note the limitations below for ESNEFT MyChart based on your child's age:

If the patient is under 12, two people with parental responsibility can be signed up as proxies (other proxies can be added at discretion of the clinician).
If the patient is 13-15, the clinician will determine if the patient is also capable of having a MyChart account. Two people with parental responsibility can be signed up as proxies (other proxies can be added at discretion of the clinician).
If the patient is 13+, the patient can request to remove a proxy from the MyChart at the patient's discretion
If the patient is 16+ with capacity, the patient will have direct access to MyChart; Proxy access can be provided with patient consent.
If the patient is 16-18 without capacity, proxies may be added with clinician consent.
If the patient is 18+, proxy access for a patient without full capacity can only be provided with appropriate legal verification. Information can be found here: www.gov.uk/become-deputy/apply-deputy

If you have any questions, please contact the ESNEFT MyChart helpdesk at MyChartHelpdesk@esneft.nhs.uk

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Parent/Legal Guardian's Information

First Name

Middle Initial

Surname

Date of Birth

Date of birth of the parent or legal guardian.

Address

City

Postcode

Country

Phone Number

E-mail Address

Requesting access for:

Update Existing AccountCreate New Account

If requesting access for an existing account, what is your MyChart username?

Child's Information

Child's First Name

Child's Middle Initial

Child's Surname

Child's Date of Birth

NHS Number

Find NHS number

Medical Record Number (MRN)

May be listed as the Hospital Reference Number in your letter

Relationship to Child

Birth Parent/Adoptive ParentLegal Guardian

Additional Child's Information

Child's First Name

Child's Middle Initial

Child's Surname

Child's Date of Birth

NHS Number

Medical Record Number (MRN)

May be listed as the Hospital Reference Number in your letter

Relationship to Child

Birth Parent/Adoptive ParentLegal Guardian

Additional Child's Information

Child's First Name

Child's Middle Initial

Child's Surname

Child's Date of Birth

NHS Number

Medical Record Number (MRN)

May be listed as the Hospital Reference Number in your letter

Relationship to Child

Birth Parent/Adoptive ParentLegal Guardian

Right to Access:

By signing this form, I acknowledge that I have read and understand this MyChart Request Form and I agree to its terms and conditions.

I understand that when seeking access of your child’s MyChart account, you will also need to supply proof of your child’s identity and your parental responsibility.

I hereby request access to my child and/or children’s online health record.

Right to access:

I certify that I am the patient or legally authorised representative of the patient.

Request to Access a Child's Record

Right to Access: