MyChart Access Forms



Activation Code Request for Myself

If you are 18 years or older, please go to the Sign up for your MyChart Account page. You will be able to sign up directly for MyChart after answering a few questions to verify your identy.

Download the paper HUMC MyChart Sign Up Form if you wish to send the information via postal mail.

Activation Code Request for Others - Proxy Access

What is proxy access?

Proxy access allows a person to access data in another person's medical record. Typically, parents will use this to access their children's accounts so they can schedule appointments check immunizations, reorder medications, and coordinate other health-related information for their children. Adults may also use it to access an older parent or relative's record. This is particularly useful for helping older adults monitor medications and appointments. This communication is done using a HUMC MyChart account and is restricted to non-urgent matters. Proxy access is granted once an authorization form has been completed and processed.

Parent-Child Proxy

Parent-Child proxy access allows a parent or guardian access to the HUMC MyChart account of a Hackensack University Medical Center patient who is under the age of 18. Access is obtained by completing the HUMC MyChart Child Proxy Form and mailing it to Hackensack University Medical Center. Child proxy access is automatically terminated on the child's 18th birthday. If your child is age 12-17, you will be granted partial access to your child's HUMC MyChart record (e.g., immunizations and allergies).

Parent-Teen Proxy

Parent-Teen proxy access allows a parent or guardian full access to the HUMC MyChart account of a Hackensack University Medical Center patient who is between the ages of 12 - 17. It also allows the teen access to his/her own account. Access is obtained by completing the HUMC MyChart Teen Consent Proxy Form. Teen, parent and provider must review, agree, and sign the consent form before access is granted. Teen proxy access is automatically terminated on the teen's 18th birthday. The teen's account will not expire on his/her 18th birthday. If the teen chooses to revoke proxy access, his/her own access will also be terminated

Adult-Adult Proxy

Adult-Adult proxy access allows another adult full access to the HUMC MyChart account of a Hackensack University Medical Center patient who is 18 years of age or older. In order to obtain access, both the patient and proxy must complete and sign the HUMC MyChart Adult Proxy Form and mail it to Hackensack University Medical Center. The proxy's access is terminated when the patient makes a written request to terminate access or revokes access from within their MyChart account.

Submit Proxy Request Forms:

Download the appropriate form and mail it to Hackensack University Medical Center, Health Information Department, 30 Prospect Avenue, Hackensack, NJ 07601 OR Fax: 201-489-0591.

To access the patient's chart


1. Log in to your MyChart account from our secure web page with your MyChart username and password.

2. Select the tab on the right with the patient's name.

Please feel free to contact us if you have any problems at MyChart Support.

Thank you for your interest!

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