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Request Proxy Access to a Patient'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 health information. ESNEFT MyChart supports proxy access for patients of all ages, allowing authorised individuals to view certain parts of another person’s health record when appropriate. If you would like to request proxy access, please complete and submit the following form for approval. Once your request has been approved, an activation code will be emailed to you within 30 days. We will contact you if we require any additional information to process your application. Please note that proxy access is granted based on legal status, clinical assessment, and the patient’s age and capacity. For children, proxy access can only be granted to a parent or legal guardian. For adults, access may be granted with the patient’s consent or, where the patient lacks capacity, with appropriate legal authority. Information can be found here: www.gov.uk/become-deputy/apply-deputy.

Please note the limitations below for ESNEFT MyChart based on the patient'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


* Indicates a required field

Your Information

Your date of birth, as the person requesting access.

Requesting access for:

Patient's Information

Find NHS number

May be listed as the Hospital Reference Number in your letter

Relationship to Patient

Additional Patient's Information

May be listed as the Hospital Reference Number in your letter

Relationship to Patient

Additional Patient's Information

May be listed as the Hospital Reference Number in your letter

Relationship to Patient

Legal Authority:


Only complete this if you are acting under a registered Lasting Power of Attorney for health and welfare. Enter numbers only, with no spaces or dashes. The reference number is shown on the LPA document issued by the Office of the Public 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 requesting access to another person’s MyChart account, I will also need to supply proof of that person’s identity and proof of my legal right to access their record.

I hereby request access to the online health record of the patient or patients named above.


Right to access: