Nombre: | Fecha Nac.: |MRN: | PCP:

Request Access to a Minor's Record

Online proxy request is available for access to a minor's account. If you'd like to request proxy access to another adult's account, please visit the nearest Scripps location. The adult patient to whom you are requesting access must fill out and sign the Designated Personal Representative form.

We will notify you within 3 business days once proxy access has been set up, or reach out for further follow up if needed.

You will receive full access to the charts of children under the age of 12. Under federal and California law, when minors reach age 12, they have a legal right to health information privacy. In compliance with these laws, we limit the information proxies can view in their teenager's chart. While your child is between the ages of 12-17, you will be able to message their providers, review and refill medications*, schedule appointments, and track growth charts. At this time, proxy access to teens does not allow the viewing of test results, upcoming or past appointments, or letters.
*"Sensitive" medications are filtered from proxy view

If your child has diminished capacity and you need full access to their chart, please notate that below. With specific diagnoses or physician approval, full access will be granted until they turn 18.

Minor's Information:

Parent/Guardian Information: