Name: | DOB: | MRN: | PCP:

Activation Code Request

Welcome! Samaritan Health Services is pleased to offer this on line request service for your MyChart activation code. Your activation code will be your key to your personal and secure electronic medical record.

All fields are required.

Attestation:

We will email your activation code to the email address above after validating your submission with your Samaritan Health Services membership information.