Request an Activation Code

Completing this form allows Patient (18 years old or older) to be able to access the Patient's protected health information maintained by Children's Healthcare of Atlanta, Inc. and/or any of their electronic medical record affiliates (the "Organizations") through MYchart. The Patient must agree and comply with the terms and conditions on the MYchart web page, and this document.

Patient:
I acknowledge and agree that:
* I will be using my own MYchart account at the Organizations to access the Patient's MYchart account.
* I will comply with the terms and conditions on the MYchart web page and this document.
* I understand that MyChart is intended as a secure online source of confi dential medical information. If I share my MyChart log-in credentials with another person, that person may be able to view my or my child’s health information.
*I agree that it is my responsibility to select confidential log-in credentials, to maintain my log-in credentials in a secure manner, and to change my log-in credentials if I believe it may have been compromised in any way.
*I understand that if I choose to access MyChart on my own device, I do so at my own risk and that Children’s is not responsible for any of Patient’s data stored in the app.
*I understand that MyChart contains selected, limited medical information from the Patient’s medical record and does not reflect the complete contents of the patient’s medical record. I also understand that an electronic or paper copy of a patient’s legal medical record may be requested.