Please Identify Yourself

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All fields are required.
If you are not the patient, but a family member or caregiver who needs access to this chart, please complete the proxy access form: adult || child. Please do not use the patient’s activation code. For more information see MyChart Proxy Access. Please submit via fax to 203-688-8155 or email a scanned completed copy to MyChart.eHIM@ynhh.org

MyChart Activation Code

Enter your Activation Code as it appears on your enrollment letter (your code is not case sensitive). You will not need to use this code after you complete the signup process.

xxxxx
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xxxxx
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xxxxx
Date of Birth

Enter your date of birth in the format shown, using 4 digits for the year.

mm
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dd
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yyyy