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Parental Access Form

PLEASE NOTE:
Access to the child’s online record is only available to birth/adoptive parents or individuals with legal guardianship.

Parental Access to the Online Medical Record of a Patient 12 to 17 Years Old

Request Access

As a parent, you can request your child to have access to his/her online medical record.

Please describe your relationship to the child

Do you (parent/legal guardian) already have a MyPortal account?

Parent Acknowledgement

Legal Signature Acceptance

Legal Signature Acceptance

3 + 10 =

*** TIME SENSITIVE***

Once you receive the initial email from no_reply@nvrh.org,
you have 72 hours to log in and create your personal ID and Password ***
Be sure to check your junk mail.

Northeastern Vermont Regional Hospital

PO Box 905
1315 Hospital Drive
St. Johnsbury, Vermont 05819

802-748-8141  |  TTY/TTD, Dial 711

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