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I understand and agree that access to MyChart is subject to the Terms and Conditions cited below;

  • I understand that MyChart is intended as a secure online source of confidential medical information.
  • I understand MyChart contains selected, limited medical information from my medical record and does not reflect the complete contents of the medical record. I can obtain a complete copy for a reasonable fee by contacting the Health Information Department.
  • I understand that it is my responsibility to maintain my User ID and password in a secure manner, and will not share my password with anyone. If I believe my identification and password may have been compromised in any way I will contact Select Medical Corporation, Attn: Privacy Officer, 4716 Gettysburg Road, Mechanicsburg, PA 17055.
  • I understand that this authorization will continue until revoked. I may revoke this authorization in writing at any time, except to the extent that action has been taken by Select Medical Corporation in reliance on this authorization, by sending a written revocation to: Select Medical Corporation, Attn: Privacy Officer, 4716 Gettysburg Road, Mechanicsburg, PA 17055.
  • I understand that failure to comply with the terms and conditions of use for MyChart may result in the termination of MyChart access privileges.
  • I understand that my access to MyChart is provided by Select as a convenience to its patients and that Select has the right to deactivate access to MyChart at any time for any reason.
  • I understand my use is voluntary and I am not required to use MyChart or to authorize a MyChart proxy.
  • I understand that I am not required to sign this authorization form and that Select Medical Corporation will not condition the provision of treatment or payment to me on the signing of this authorization.

I understand that the information included in MyChart may include medical information considered very personal, including information about sexually transmitted and other communicable diseases, drug and alcohol abuse, HIV/AIDS, and mental health services. My health care provider, its employees, officers and physicians are hereby released from any legal responsibility or liability for disclosure of the above information to the extent indicated and authorized herein. Note: Neuropsychology/psychologist notes require a Separate authorization and is not be accessible via MyChart.