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Screen readers: use read next line command to hear instructions."), "Global"); </script> </head> <body onload="enableInputs(); accessCheckBodyLoad(); assignInlineEventHandlers(); $$WP.IEHardStopDisabled=true; WP.DOM.Browser.checkBrowserSupported(); setFederatedLogoutMode(true);" class="accessPage hasNoCommunityLinks isPrelogin color1 graphicHeader md_default"> <div id="classicPopupRoot" class="overlayContainer"><div id="onboarding-content" class="jqHidden"></div></div><div id="wrap" class="withSidebar" data-hide-during-popup="true"><header id="header" class="prelogin"></header><div id="content" class="hasSidebar"><main id="main"><a class="logo" href="/MyChart-PRD/" title="Mass General Brigham Patient Gateway"></a><div class="title"><h1 class="header">Please Identify Yourself</h1></div><div id="accessErrorMessage" class="alertHeader"></div><p class="pretext"></p><p class="pretext">All fields are required.</p><form autocomplete="off" method="post" action="/MyChart-PRD/accesscheck.asp" id="accessForm"onsubmit="return doAccessCheck(0,1,'/MyChart-PRD/en-US/Images/warning.png',0,1,'accessErrorMessage','accessForm',9);"><div class="formcontents"><div class="hidden"><input type="hidden" class="hidden" name="accessformtoken" value="7D93A9AE199148BB9B7E423537C4B34A" /></div><script type="text/javascript">var sEmptyFieldErrorAccess = HTMLUnencode("<span class="clearlabel">Error: </span>Please enter your activation code."), sInvalidFieldErrorAccess = HTMLUnencode("<span class="clearlabel">Error: </span>Invalid activation code.");</script><fieldset class="formsection legacyLabelledField"><legend class="fieldGroupPrompt required">Mass General Brigham Patient Gateway activation code</legend><p class="helptext">Enter your activation code as it appears on your enrollment letter or After Visit Summary®. Your code is not case sensitive.</p><label class="clearlabel inlinelabel" for="code1">Activation Code Part 1</label><div class="segment5"><input disabled="disabled" class="disabledfield jsreq" type="text" name="code" id="code1" maxlength="5" value="" onblur="isDiscreteFieldsError('code','2','1','codeerror',sEmptyFieldErrorAccess,sInvalidFieldErrorAccess,'',this,'1','');" onkeyup="autotab(event,this,document.getElementById('code2'));isDiscreteFieldsError('code','2','1','codeerror',sEmptyFieldErrorAccess,sInvalidFieldErrorAccess,'1',this,'1','');" onkeydown="checkIfTabAllowed(event,this); checkIfFocusOnPrevField(event,this,'code',1);" onclick="selectIfFull(this);" onkeypress="removeCharFromField(event,this,'-','1');" /><div class="helptext accessibleLabel">xxxxx</div></div><span class="separator">-</span><label class="clearlabel inlinelabel" for="code2">Activation Code Part 2</label><div class="segment5"><input disabled="disabled" class="disabledfield jsreq" type="text" name="code" id="code2" maxlength="5" value="" onblur="isDiscreteFieldsError('code','2','1','codeerror',sEmptyFieldErrorAccess,sInvalidFieldErrorAccess,'',this,'1','');" onkeyup="isDiscreteFieldsError('code','2','1','codeerror',sEmptyFieldErrorAccess,sInvalidFieldErrorAccess,'1',this,'1','');" onkeydown="checkIfTabAllowed(event,this); checkIfFocusOnPrevField(event,this,'code',2);" onclick="selectIfFull(this);" onkeypress="removeCharFromField(event,this,'-','1');" /><div class="helptext accessibleLabel">xxxxx</div></div><div id="codeerror" class="alert signUpFieldError"></div></fieldset><script type="text/javascript">var sEmptyFieldErrorDOB = HTMLUnencode("<span class="clearlabel">Error: </span>Please enter your date of birth."), sInvalidFieldErrorDOB = HTMLUnencode("<span class="clearlabel">Error: </span>Invalid date of birth.");</script><fieldset class="formsection legacyLabelledField"><legend class="fieldGroupPrompt required">Date of birth</legend><p class="helptext">Enter your date of birth in the format shown, using 4 digits for the year.</p><label class="clearlabel inlinelabel" for="dob1">Month of birth</label><div class="segment2"><input disabled="disabled" class="disabledfield jsreq" type="text" name="dob" id="dob1" maxlength="2" value="" onkeyup="autotab(event,this,document.getElementById('dob2')); isDiscreteFieldsError('dob','3','1','doberror',sEmptyFieldErrorDOB,sInvalidFieldErrorDOB,'1',this,'1','1');" onkeydown="easyDOBEntry(this,1,'',1); checkIfTabAllowed(event,this); checkIfFocusOnPrevField(event,this,'dob',1);" onblur="easyDOBEntry(this,1); isDiscreteFieldsError('dob','3','1','doberror',sEmptyFieldErrorDOB,sInvalidFieldErrorDOB,'',this,'1','1');" onclick="selectIfFull(this);" onkeypress="removeCharFromField(event,this,'/','2');" /><div class="helptext accessibleLabel">mm</div></div><span class="separator subtle">/</span><label class="clearlabel inlinelabel" for="dob2">Day of birth</label><div class="segment2"><input disabled="disabled" class="disabledfield jsreq" type="text" name="dob" id="dob2" maxlength="2" value="" onkeyup="autotab(event,this,document.getElementById('dob3')); isDiscreteFieldsError('dob','3','1','doberror',sEmptyFieldErrorDOB,sInvalidFieldErrorDOB,'1',this,'1','1');" onkeydown="easyDOBEntry(this,1,'',1); checkIfTabAllowed(event,this); checkIfFocusOnPrevField(event,this,'dob',2);" onblur="easyDOBEntry(this,1); isDiscreteFieldsError('dob','3','1','doberror',sEmptyFieldErrorDOB,sInvalidFieldErrorDOB,'',this,'1','1');" onclick="selectIfFull(this);" onkeypress="removeCharFromField(event,this,'/','2');" /><div class="helptext accessibleLabel">dd</div></div><span class="separator subtle">/</span><label class="clearlabel inlinelabel" for="dob3">Year of birth</label><div class="segment4"><input disabled="disabled" class="disabledfield jsreq" type="text" name="dob" id="dob3" maxlength="4" value="" onkeyup="isDiscreteFieldsError('dob','3','1','doberror',sEmptyFieldErrorDOB,sInvalidFieldErrorDOB,'1',this,'1','1');" onkeydown="easyDOBEntry(this,1,1,1); checkIfTabAllowed(event,this); checkIfFocusOnPrevField(event,this,'dob',3);" onblur="easyDOBEntry(this,1,1); isDiscreteFieldsError('dob','3','1','doberror',sEmptyFieldErrorDOB,sInvalidFieldErrorDOB,'',this,'1','1');" onclick="selectIfFull(this);" onkeypress="removeCharFromField(event,this,'/','2');" /><div class="helptext accessibleLabel">yyyy</div></div><div id="doberror" class="alert signUpFieldError"></div></fieldset><div class="formsection legacyLabelledField"><label for="zip" class="fieldGroupPrompt required">ZIP code</label><p class="helptext">Please enter your ZIP code.</p><script type="text/javascript">var sEmptyFieldErrorzip = HTMLUnencode("<span class="clearlabel">Error: </span>Please enter your ZIP code.");var sInvalidFieldErrorzip = HTMLUnencode("<span class="clearlabel">Error: </span>Invalid ZIP code.");</script><div class="segment5"><input disabled="disabled" class="disabledfield jsreq" type="text" name="zip" id="zip" value="" maxlength="10" onkeyup="isBasicInlineValidationError(this,'ziperror',sEmptyFieldErrorzip,'','1','','','','1','',-1);" onblur="isBasicInlineValidationError(this,'ziperror',sEmptyFieldErrorzip,'','','','',sInvalidFieldErrorzip,'','',-1);" /><div class="helptext accessibleLabel">xxxxx</div></div><div id="ziperror" class="alert signUpFieldError"></div></div><div class="formsection formbuttons"><input class="hidden" type="hidden" id="jsenabled" name="jsenabled" value="0" /><input class="hidden" type="hidden" name="nfrmhypsp" value="1" /><input class="hidden" type="hidden" name="access" value="Next" /> <input class="button disabled jsreq nextstep" type="submit" name="access" id="access" value="Next" title="" disabled="disabled"/></div> </div></form></main><aside id="sidebar"><div id="locale_container" class="prelogin"><div class="dropdown"><button class="linkcolor" id="localeswitch" aria-haspopup="true"><img class="localeImg" src="/MyChart-PRD/en-US/images/locale_switch.png" alt="Select a 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