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Cleveland Clinic fax number
(216) 636-0991
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MyChart Caregiver Area / Health Data Services
Used for: MyChart caregiver access request (proxy access) for a patient
Fax destination details
- Department
- MyChart Caregiver Area / Health Data Services
- Purpose
- MyChart caregiver access request (proxy access) for a patient
- Form
- Form A — MyChart Caregiver Request (Adult Proxy Form)
- Address
- Ab-7, 9500 Euclid Ave, Cleveland, OH 44195
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Complete Form A and transmit it to Cleveland Clinic via fax to 216-636-0991 or mail to Cleveland Clinic, Ab-7, 9500 Euclid Ave, Cleveland, OH 44195. The form collects requester and patient information, caregiver details, and the requested MyChart access level.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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