Request to Access a Child's Record

Thank you for your interest in MyChart BWC, 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 MyChart BWC 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 BWC can only be granted to a Parent or Legal Guardian.

Please note the limitations below for MyChart BWC 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 12-16, 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 BWC at the patient's discretion
• If the patient is 16+ with capacity, the patient will have direct access to MyChart BWC; 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 a court order or other legal verification. Information can be found here: www.gov.uk/become-deputy/apply-deputy

If you have any questions, please contact the MyChart BWC helpdesk at bwc.mychart@nhs.net

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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 BWC 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 BWC Request Form and I agree to its terms and conditions. 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 authorized representative of the patient.