Name: | DOB: | MRN: | PCP:

Activation Code Request

Welcome! Infirmary Health System is pleased to offer this on line request service for your MyiHChart activation code. Your activation code will be your key to your personal and secure electronic medical record. Please fill out all fields, as they are required to verify your Medical Record.

We will mail your activation code to the address above after validating your submission with Infirmary Health Medical Record Information. Should we have any questions regarding your submission, we will contact you via the home phone number you have submitted.