Add or Change an Organization/Facility - eHRViewer Request Form

Complete the following form and click submit.

Only the work titles listed in the drop down are able to receive access to the eHR Viewer at this time.

If you have questions, please contact the Service Desk.


Last Name *
First Name *

Organization Name *
Facility

Work Phone *
Work Title *

User ID

Registration number
Physician only- CPSS is granted by the College of Physician and Surgeons, Not MSB billing Number


* Mandatory Field

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