EpicCare Link Request Form

If you are a member of an organization who doesn’t currently have an EpicCareLink account with Monument Health or you are requesting access for several individuals, please contact us by phone at 605-755-8131, Option 2, for more information. If your organization already has EpicCare Link access, please continue.

A Confidentiality Agreement must be completed as part of the online form fill-out. Download the form here, sign and upload/attach below. Then fill out the rest of the online form. You will receive an email with confirmation and your log-in details.

Confidentiality Agreement (Upload/Attach)*
Accepted file types: pdf, doc, docx, Max. file size: 2 MB.
First Name*
Middle Initial
Last Name*
Job Title*
Company Name (Organization You Work For)*
Company Address*
Business Phone Number*
Business Email*
Date of Birth (Only Used for Verification)*
MM slash DD slash YYYY
Last 4 Digits of Social Security Number (Only Used for Verification)*
Are you an admissions coordinator at a nursing home?*
- Yes
- No
Providers Only
Please choose ONE of the following notification settings (these settings do not affect your access).
Notification Setting
- Full
- Notification Only
- None
Full: All items that require attention, including actionable items or notifications, will be sent to your EpicCare Link InBasket. By choosing this option you agree to respond to actionable requests received in your InBasket at least twice per week.

Notification Only: Only non-actionable notifications, such as notification of your patient’s admission to the hospital, will be sent to your EpicCare Link InBasket. All actionable items, such as a provider requesting a consult or patient requesting a refill, will be communicated via other methods, such as phone or fax.

None: You do not plan to use EpicCare Link for ANY communications in the near future. You will rely solely on communicating via other methods, such as phone or fax.
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EpicCare Link Request Form

Providers Only