MyEMH Record

MyEMHRecord

Request for Access Form

Thank you in advance for your interest in MyEMH Record, a web-based patient portal that provides you with a secure and convenient way to access your health information. Please complete this form to request access to the MyEMH Record Patient Portal.

* Denotes required fields

Your Information


If required fields on access form do not match information that exists in Elmhurst Memorial Hospital Information system, we will require you to appear in person at the Elmhurst Medical Record  Department with a valid state issued ID or driver's license before we will grant you access to the portal.

A valid email address is required in order to utilize the MyEMH Record Portal.
Please provide a current private email address and verify its accuracy. By providing an email address, you agree to have Elmhurst Memorial Healthcare communicate with you regarding the MyEMH Record Portal via email. Absolutely no protected health information will be included in any email communications from Elmhurst Memorial Healthcare.

 * By checking this box, I acknowledge that I am requesting access to my health information in MyEMH Record. I understand that access to patient portal will not expire unless I notify Elmhurst Memorial Healthcare in writing to discontinue portal access.

 * 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 application to access the MyEMH Record service.



Already have a
MyEMH Record Account?

LOG IN

First Time User?

Know Your Medical Record Number (MRN)?

SELF-ENROLL HERE

Do Not Know Your Medical Record Number (MRN)?

REQUEST ACCESS
Elmhurst Memorial Healthcare Network

This site is part of the Elmhurst Memorial Healthcare network of Web sites, which covers a variety of topics using the same philosophy: When it comes to medical care, we know that you have a lot of options. And we want you to know that you're more than a patient to us. You're an individual. We would appreciate the opportunity to provide you with state-of-the-art medical care and down-to-earth, personalized attention.

Get our classes & events newsletter

View more Newsletters