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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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En Español
Option 1    
Option 1 Icon

I am a PARENT or LEGAL GUARDIAN requesting access for a patient under 18 years old. There are no restrictions legally or otherwise preventing my legal right to access.

PARENT/LEGAL GUARDIAN PROXY Authorization for MyChart Dependent
Account- Minor Child

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.

Authorization for MyChart “Dependent” Account

Option 3    
Option 3 Icon

I am a PATIENT 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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