Home › Employees › EpicCare Link Request

EpicCare Link Request

Complete the form below to request access to Epic. If you have any questions or need assistance, please contact the Help Desk at (228) 809-1777 or email help.desk@mysrhs.com.

"*" indicates required fields

Organization Information

Organization Name*

Providers*

Manager's Email Address*

Manager's Phone Number*

Account Information

End User's Name*

First Middle Last

End User's Email*

End User's Phone*

Job Title*

Last Four Digits of SSN*

Is This a Request for Access for a Research Study?*

Yes