Request to connect medical records to a third party app

Request form to connect your medical records to a third-party app

To connect your AHN medical records to a third-party app, you must fill out the form fields below. Our team will be in touch within 10 business days to let you know if your request is approved. 

This form is not for general MyChart assistance. If you need general MyChart assistance, call 1-833-246-2478 or email mychart@ahn.org.

I’d like to release my health information to a third-party app

Your contact information

Valid * Required
Valid * Required
Valid * Required
Valid * Required

Information on the third-party app

Valid * Required
Valid * Required
*

This form only requests to grant access to your medical records by third-party apps, such as Apple or Google Health. Go to MyChart FAQ's for information about all other legal proxy access requests.