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 will keep my password confidential and not share this information with anyone.