Terms & Conditions:
Affirmation:
I hereby affirm that I am the patient identified above. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this request to access MyHealth.
Authorization:
By submitting this form I agree to allow Essentia Health to release my personal health information to me via an online MyHealth account. I will be able to access information maintained in MyHealth for my personal use.
I understand that:
- This authorization will be valid for as long as I maintain an active MyHealth account.
- If I change my mind and no longer want MyHealth access, I may let Essentia Health know in writing at any time. This change will become effective no later than the next business day after the date that Essentia Health receives my request and will not apply to information that has already been released before this effective date.
- Essentia Health cannot be responsible for the confidentiality of information released to me, and cannot prevent me from releasing the information to another person. At that time, the information is no longer protected by federal and state privacy regulations.
- If I do not create a MyHealth account, I will still be treated and payment, enrollment and eligibility for benefits will not be impacted.
- I designate my MyHealth account as my preferred method of communication to receive reminders about preventive and follow-up care (excludes scheduled appointment reminders).
- As part of this on-line account creation process I will be asked to confirm that I have read and agree to the Essentia Health MyHealth Terms and Conditions. I understand that every time I use MyHealth I agree to these Terms and Conditions.
By clicking "Agree & Submit" I confirm that I have read and agree to the terms of this authorization. I acknowledge that I am electronically submitting this authorization on my own behalf. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this authorization.
Terms & Conditions
Affirmation
I hereby affirm that I am the patient identified above. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this request to access MyHealth.
Authorization
By submitting this form I agree to allow Essentia Health to release my personal health information to me via an online MyHealth account. I will be able to access information maintained in MyHealth for my personal use.
I understand that:
- This authorization will be valid for as long as I maintain an active MyHealth account.
- If I change my mind and no longer want MyHealth access, I may let Essentia Health know in writing at any time. This change will become effective no later than the next business day after the date that Essentia Health receives my request and will not apply to information that has already been released before this effective date.
- Essentia Health cannot be responsible for the confidentiality of information released to me, and cannot prevent me from releasing the information to another person. At that time, the information is no longer protected by federal and state privacy regulations.
- If I do not create a MyHealth account, I will still be treated and payment, enrollment and eligibility for benefits will not be impacted.
- I designate my MyHealth account as my preferred method of communication to receive reminders about preventive and follow-up care (excludes scheduled appointment reminders).
- As part of this on-line account creation process I will be asked to confirm that I have read and agree to the Essentia Health MyHealth Terms and Conditions. I understand that every time I use MyHealth I agree to these Terms and Conditions.
By clicking "AGREE & SUBMIT" I confirm that I have read and agree to the terms of this authorization. I acknowledge that I am electronically submitting this authorization on my own behalf. I understand that I may be subject to penalties under law for submitting false or misleading information in connection with this authorization.
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