Use this form to request a MyChart account. Please fill out the form as completely as possible. If you do not know your Account Number or Medical Record Number, leave the field blank and a CMH representative will contact you to complete your MyChart registration. Once you have been registered for the MyChart, you will receive an email from email@example.com with instructions to complete your account registration.
Proxy access must be requested in person at a CMH Clinic or the Health Information Management department at the hospital. The patient granting proxy access to their account must present picture identification in accordance with HIPAA regulations.