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What type of access can we help you with?

Please select an option below. Print the required form and return it to:

FirstHealth of the Carolinas
Privacy Office
PO Box 3000
Pinehurst, NC 28374
Fax: (910) 715-2398

FirstHealth MyChart Logo
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Option 1    
Option 1 Icon

I am a parent or legal guardian requesting access for a patient under 13 years old.

PARENT/LEGAL GUARDIAN PROXY AUTHORIZATION FOR MYCHART DEPENDENT ACCOUNT- MINOR CHILD PDF

 
Option 2    
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I am a family member or friend requesting access to an adult or emancipated minor's health information in FirstHealth MyChart.

PERMANENT LEGAL GUARDIAN/HEALTHCARE POWER OF ATTORNEY
AUTHORIZATION FOR MYCHART “DEPENDENT” ACCOUNT
PDF

 
Option 3    
Option 3 Icon

I am a patient 13 or older requesting that access be given to another person.

PATIENT AUTHORIZATON - PROXY ACCESS TO MY FIRSTHEALTH OF THE CAROLINAS MYCHART ACCOUNT PDF

 

Need assistance? Call FirstHealth at (910) 715-2434.

*Access to another person's account is also known as proxy. Access by proxy will only be granted if, and only to the extent, deemed clinically appropriate and allowable under North Carolina and federal law. Proxy access is also conditioned to compliance with the FirstHealth MyChart Terms and Conditions.

 
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