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UHC Chart Request

Welcome! United Hospital Center is pleased to offer this online request service for your access to UHC Chart. Please fill out all fields, as they are required to verify your UHC Chart membership. This is not to be used to request "proxy" access for any of your family members.
First Name:
Last Name:
SSN(Last Four digits):
Street Address:
Zip Code:
Home Phone(xxx-xxx-xxxx):
Email Address:

By Selecting "Submit" you are agreeing to the Terms and Conditions outlined within this web page. Should we have any questions regarding your submission, we will contact you via the home phone number you have provided.