User Electronic Mail Authorization Form
FollowMyHealth™ Portal Consent
FollowMyHealth™ Patient Portal
The Iredell Memorial Hospital (“IMH”) Patient Portal (“Portal”)
offers patients convenient and secure access to their personal health
information. You are in control of your Portal account. IMH will not activate
your Portal account unless authorized. This only occurs when you provide
your electronic mail (email) address and sign this form. Your decision
to provide your email address and sign this form is completely voluntary.
If you provide your email address to IMH, please note that IMH may use
your email address for other purposes in accordance with applicable law;
however, IMH will not share your email address with others.
If you choose not to complete this form, you will not be able to access
personal health information from IMH using the Portal. If you complete
this form, you consent to have IMH contact you for verification and to
email you a unique link. For your protection, the unique link from IMH
will expire after 30 days if not used. Once the link expires, you must
present in person to the Medical Records Department at Iredell Memorial
Hospital for assistance.
You will use the link to create a connection to the Portal. You will need
your patient security code to sign up for access to the Portal. Your security
code is the last 4 numbers of your primary phone number.
Personal identifying information and other health and medical history information
are available via the Portal. Please choose an email address that will
not be used or accessed by anyone else. When you first log-on to the Portal,
it will prompt you to create a password for your Portal. It is very important
to keep your password private. Do not share your password with anyone
or write your password in a place easily accessible to others.
If you provide your email address, you will be contacted to verify your
identity, after which you will receive an email with information to access
the Portal and authorize IMH to make your personal health information
available via the Portal. You are also authorizing IMH to use your email
address for other purposes permitted by law. The terms and conditions
of the Portal shall apply to this User Electronic Mail Authorization Form.
Please indicate on the form above that you have read and accept the conditions
of the consent form by clicking the box above the Submit button.