Step 1 of 3: By completing the enrollment form below, you authorize The Christ Hospital Health Network to release your protected health information to you via MyChart. This authorization is effective until your MyChart account is
inactivated and includes records that were created or existing on or before the date you signed up for MyChart, as well as records that are created after today. You also understand that the information to be released may include
information relating to the diagnosis and/or treatment of mental illness, alcohol/drug abuse, STD's, HIV test results, developmental disabilities, and genetic testing results. You have the right to revoke this authorization at any time
by contacting your physician's office. This revocation will not apply to information that has already been released.All fields are required.