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I understand that MyChart is intended as a secure online source of confidential medical information. If I share my MyChart username and password with another person, that person may be able to view my health information.

I agree that it is my responsibility to select a confidential password, to maintain my password in a secure manner, and to change my password if I believe it may have been compromised in any way.

I understand that MyChart contains selected, limited medical information from a patient's medical record and that MyChart does not reflect the complete contents of the medical record. I also understand that a paper copy of a patient's medical record may be requested from the patient's clinic.

I give my consent for CentraCare and affiliates to release all information, as defined in the MyChart Terms and Conditions, to the MyChart Account so that I may view this information online.

I understand that my activities within MyChart may be tracked by computer audit and that entries I make may become part of the medical record.

I understand that access to MyChart is provided by CentraCare and affiliates as a convenience to its patients and that CentraCare has the right to deactivate access to MyChart at any time for any reason. I understand that use of MyChart is voluntary and I am not required to use MyChart or to authorize a MyChart proxy.

I understand that once information is released pursuant to this authorization, CentraCare and affiliates cannot prevent the re-disclosure of the information to another third party.

I understand this authorization must be filled out completely. By using MyChart, I acknowledge that I have read and understand this MyChart Terms and Conditions and I agree to its terms.

I understand that this consent will remain in effect until I provide CentraCare with a written request for revocation.


You may choose to use other services provided by third parties in conjunction with your use of MyChart. Such services may include, but are not limited to, translation services, location services, and other third-party offerings. Any links to such services are provided for your convenience only. Neither Epic nor CentraCare and affiliates have control over the contents of these services, and neither Epic nor CentraCare and affiliates accept any responsibility for them or for any loss or damage that may arise from your use of them. Such services may require you to submit your information to a third party, which may result in a copy of your information being used and/or stored by a third party. If you decide to access any such services in conjunction with your use of MyChart, you do so entirely at your own risk and subject to the terms and conditions of use for such services.