UCHC, Inc. EMPLOYEE HEALTH REQUESTS FOR COVID TESTING

& VACCINE REGISTRATION INTO OCHIN

Please complete this form if you are a UCHC employee requesting a Covid test/Vaccine at UCHC due to exposure/symptoms and you do not want to call the Covid line at 617-388-5007. If you want a test/Vaccine for personal reasons, such as travel or to see relatives/friends, you must follow the regular process by calling the Covid line.

We strongly recommend you sign up for MyChart, the patient portal to get your results. It is much easier and straightforward to get your results this way and has less of a burden on our staff resources. (Information regarding MyChart enrollment is provided when you get the Covid test/Vaccine.)

Are you already registered in OCHIN/EPIC? If, yes, please only enter your name, contact phone number, and any information that may have changed since the last time you were seen including insurance information. If not, please provide all information below.

Employee COVID