MyDCH User Requisition

This Agreement must be completed and signed by each individual (“User”) requesting access to Driscoll Children’s Hospital’s (“Driscoll”) MyDCH, an electronic portal established to enable the sharing of protected health information contained in Driscoll’s electronic medical record via a secure, web-based electronic communication system. The Agreement must be completed and approved by the Driscoll Information Technology Department before access will be granted.

Fields marked with a * are required

Organization/Company Clinic

Individual Requesting Access (User)

Please read our terms of this Agreement.