MyUofMHealth -

This form is for patients ages 13 – 17 years to request a personal MyUofMHealth Patient Portal. If you are a parent of an adolescent click here to request proxy access.

Please fill out the information below to request your personal MyUofMHealth patient portal.

Your Medical Record Number or MRN is a 9-digit number that can be found on most of your Michigan Medicine paperwork or on your inpatient wristband. It is different from your billing account number and student ID. If you cannot locate your MRN, contact the HIE Support Help Desk at 734-615-0872 between 7:00 am – 7:00 pm, Monday through Friday or 8:00 am – 1:00 pm on Saturday.

Requirements

I am a patient that is between ages 13 and 17 years old.
I understand that this MyUofMHealth patient portal request is for me to have access to my own information.
I must have my own personal email address.
I understand that I should not share my username and password with anyone.
I understand that this account will not expire when I turn 18.
I understand that this request will not prevent my parents/legal guardians from requesting their own (proxy) access to my information.
I understand that the information I see might be different from what my parents/legal guardians can see. For more information visit FAQ.
I understand that this request requires a physician’s approval. The HIE Support Team will contact the University of Michigan Health – Michigan Medicine physician that I list on this form to approve my access.
I understand that if my physician does not respond or denies my request for access, the HIE Support Team will notify me.

Last Name:

First Name:

Middle Name:

Date of Birth(mm/dd/yyyy):

Medical Record Number (xxxxxxxxx):

Email Address:

Re-enter Email Address:

Country

Street Address:

City:

State:

Zip Code(xxxxx):

Phone Number(xxx-xxx-xxxx):

University of Michigan Health Physician Name:

I hereby affirm that I am the patient identified above. I understand that submitting false or misleading information related to this application might revoke my access to MyUofMHealth.

I am at least 13 years old and am requesting access to my own chart. I understand that the parents/guardians may have limited access to my account which includes information about allergies, immunizations and message center.

Please allow 7 business days for a MyUofMHealth.org activation code and login instructions to be emailed after validating your submission. When you receive your activation code, return to this website and complete the steps to activate your account.

Back to the Login page

MyUofMHealth Adolescent Access Request Form