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Patient Request for Access to Protected Health Information

Details: Johnston Health Johnston Health, Attn: Health Information Management – Release of Information, PO Box 1376, Smithfield, NC 27577; (fax) 919-934-9266; (phone) 919-938-7705 Margaret R. Pardee Memorial Hospital Pardee, ATTN: HIM – Release of Information, 800 North Justice Street, Hendersonville, NC 28791

› Verified 4 days ago

› Url: https://myuncchart.org/MyChart/en-us/docs/ROIRequestForms/UNC_Entity_PHI_Request.pdf Go Now

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NC Residency Income and Assets Tax Return

Details: health care and is available to patients and families with a household income at or below 250% of the Federal Poverty Guideline for your family size who are North Carolina residents. To determine your eligibility, please complete the enclosed application …

› Verified 1 days ago

› Url: https://myuncchart.org/MyChart//en-US/docs/Financial%20Assistance%20Application-english.pdf Go Now

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OB Ultrasound Cardiac Services EEG ECG Sleep Studies PFT

Details: For the result types listed below, UNC Health Care will only release general information and no additional details on the findings. Vascular Ultrasound Electrophysiology Cardiac Catheterization Echocardiography OB Ultrasound Cardiac Services – Doppler, …

› Verified 3 days ago

› Url: https://myuncchart.org/mychart/en-US/docs/results.pdf Go Now

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Authorization for Health Care Power of

Details: Health Care Power of Attorney-Legal Proxy must attach copies of: 1) the valid Health Care Power of Attorney; and 2) the Physician Certification verifying Patient lacks decisional capacity. NOTE: This option is not available in the case of an incompetent emancipated minor patient.**

› Verified 5 days ago

› Url: https://www.myuncchart.org/mychart/publicforms.asp?mode=showform&formname=CustSvcGrantPOAAccessPublic Go Now

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Parent/Legal Guardian Access to Minor Patient's Health

Details: My UNC Chart -. Name: | DOB: | MRN: | PCP: Parent/Legal Guardian Access to Minor Patient's Health Information in My UNC Chart. Back to the Login Page.

› Verified 2 days ago

› Url: https://myuncchart.org/MyChart/publicforms.asp?mode=saveform&requestsent=true&formtitle=Parent%2FLegal+Guardian+Access+to+Minor+Patient%27s+Health+Information+in+My+UNC+Chart Go Now

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Instructions for a scheduled Video Visit via My UNC Chart

Details: Instructions for a scheduled Video Visit via My UNC Chart (These instructions are accessible when signed into My UNC Chart) 1 After logging into My UNC Chart you should see your video visit appointment on the Welcome page with the words Begin your “appointment time” video visit with “provider’s name”. Click on these words.

› Verified 8 days ago

› Url: https://myuncchart.org/MyChart/en-us/docs/VideoVisitInstructions.pdf Go Now

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My UNC Chart is ending support for Internet Explorer

Details: To use My UNC Chart, switch to a supported browser. Use the links below to learn more about other browsers and how you can download them. Google Chrome

› Verified 4 days ago

› Url: https://myuncchart.org/MyChart/Home/UnsupportedBrowser Go Now

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Non-Covered Service Waiver Form

Details: Non-Covered Service Waiver Form By clicking “ACCEPT” in My UNC Chart, I agree with the following terms. For the Patient/Member As a member of one of the following insurance plans: Cigna, NCBCBS, Aetna, United Health, Cigna, Tricare, Medicare, I understand that I am responsible for all costs associated with the item listed below.

› Verified 3 days ago

› Url: https://myuncchart.org/MyChart//en-us/docs/EVisitWaiverForm.pdf Go Now

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You're Almost Done

Details: It looks like you have a MyChart account, but it is inactive. Go ahead and complete this process. Call us about reactivating your MyChart access.

› Verified 9 days ago

› Url: https://myuncchart.org/mychart/SignupAndSchedule/ Go Now

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Parent/Legal Guardian Access to Minor Patient's Health

Details: Parent/Legal Guardian Access to Minor Patient's Health Information in My UNC Chart. Parents and Legal Guardians may request access to their minor child’s electronic protected health information in My UNC Chart by completing this form if the minor child: • Has not reached his/her 18th birthday; • Is not married; • Is not legally

› Verified 4 days ago

› Url: https://myuncchart.org/mychart//publicforms.asp?mode=showform&formname=CustSvcGrantAdultAccessPublic Go Now

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Login Recovery Page

Details: If the information you submitted matched a My UNC Chart account in our records, your username has been sent to the email address on file.

› Verified 7 days ago

› Url: https://myuncchart.org/MyChart/recoverlogin.asp?moworkflow=complete Go Now

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