AveraChart Proxy Access

Do you need access to your child's or adult's record?

AveraChart lets you view your child's or another adult's health information and you can give another adult access to your AveraChart account. Child age restrictions apply.

Please download the proxy form, complete and return to your clinic or fax to 605-322-8223. Records for children 12 years old or older cannot be accessed without a completed proxy form. Proxy access for minors is limited to parents and legal guardians.

• Proxy Form English
• Proxy Form Spanish
• Proxy Form - Addiction Records Only (English)
• Proxy Form - Addiction Records only (Spanish)

How to Remove Proxy Access

You have a right to revoke or remove an authorization for access to your AveraChart. Follow the step-by-step instructions on this form to update your proxy or shared access. You can also complete and follow the instructions on the Proxy Revocation Form If you need assistance with proxy access, contact the AveraChart help desk at 1-855-667-9704.