Lake Shore Pediatrics - Barrington fax number

Fax destination details

Department

Medical Records / Administration - Lake Shore Pediatrics, Barrington location

Purpose

Submitting Guardian/Power of Attorney Access Authorization form (MyChart) to the Barrington clinic; forms processed and communications (activation letters, confirmations) returned to the sender.

Form

Form 5728 — Guardian/Power of Attorney Access to the Online MyChart Record of a Patient Age 12 or Older

Address

27750 West Highway 22, Suite 150, Barrington, IL 60010

Voice phone

847-381-2428

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 Guardian/Power of Attorney Access Authorization; attach required documentation; fax or mail to the child’s primary clinic location as directed (Barrington). The form outlines requirements and procedures for access to a patient’s MyChart record.

Official form instructions are published as a downloadable file on the organization's website.