Demographic Information


  • About me

    Full Name: -

    Date of Birth: -

    Gender: -

    Marital Status: -

    Preferred Language: -

    Race: -

    Ethnicity: -

    Contact Information

    Address: -

    Email: -

    Home Phone: -

    Work Phone: -

    Cell Phone: -

Insurance Information

My Insurance List

  • Insurance name

    Insurance Information

    Card Holder Name:

    Insurance Company:

    Group:

    Policy Number:

    Contact Phone:

    Subscriber Information

    Relation with Card Holder:

    Date of Birth:

    Address:

    Phone:

Insurance Information

All fields below marked with an asterisk (*) are required.

Subscriber Information

Pending Insurance Information

Relative Account Profile

Full Name: -

Date of Birth: -

Email: -

Contact Phone: -

Address: -

Manage Sharing My Health Record

You can authorize famlily members to view your medical records and contact clinic staffs via secure messaging. You can discontinue any authorized access and reassign new PIN for a pending access.

Father: Jimmy Fallen [jimmyfallen@gmail.com]

DOB: 12/21/1957 - Phone: 310-232-1122

waiting for relative confirmation

Authorize a Relative

You need to provide the following information below to authorize your family member view your medical record. If he/she is not in the network, a system email will send out with a link.

Please keep a record of the 4-digit PIN number you set, your family member will need it for the first access to your medical record.








Available Medical Records

Daughter: Jimmy Fallen (DOB: 10/22/1991)

Contact Phone: 310-232-1122

Active access from 10/11/2012 to 10/15/2015

Pending Medical Records

Father: Jimmy Fallen

authorize on 10/11/2012

My Clinic

BOONE COUNTY - LEBANON OUT PATIENT

Address: 602 Ransdell Road
Lebanon, IN

Phone:765-482-7100

HAMILTON COUNTY - ADMINISTRATIVE OFFICE

Address: 9615 East 148th Street, Suite 1
Noblesville, IN

Phone:317-587-0500

HAMILTON COUNTY - NOBLESVILLE OUT PATIENT

Address: 17840 Cumberland Road
Noblesville, IN

Phone:317-773-6864

HAMILTON COUNTY - CARMEL OUT PATIENT

Address: 697 Pro-Med Lane
Carmel, IN

Phone:317-574-0055

MADISON COUNTY - BROWN ST. OUT PATIENT

Address: 2020 Brown Street
Anderson, IN

Phone:765-641-8389

MADISON COUNTY - CHASE STREET

Address: 1933 Chase Street
Anderson, IN

Phone:765-622-7466

MADISON COUNTY - BOLIN BUILDING

Address: 2009 Brown Street (Bolin Building)
Anderson, IN

Phone:765-608-6600

MADISON COUNTY - ELWOOD OUT PATIENT

Address: 10731 State Road 13
Elwood, IN

Phone:765-552-5009

MARION COUNTY - Washington & Pike Townships only

Address: 2506 Willowbrook Parkway Suite 300
Indianapolis, IN

Phone:317-257-3903

Phone: (Voice) 317-475-7270

Phone: (Videophone) 317-493-0422

Fax: 317-475-7280

My Doctor List

    Security

    Login Information

    User ID:

    Password:**************

    Security Questions

    Activity History