The following forms and authorizations are intended to request information from your NIH Clinical Center medical record and account access to the NIH Clinical Center FollowMyHealth® Patient Portal.
Parents/guardians of patients 0-17 years of age can request a proxy account in the portal, which is linked to the minor patient's NIH Clinical Center medial record. Family members and other caregivers for adult patients may also obtain proxy access to the patient's NIH Clinical Center medical record. To request a proxy account please select Proxy Account Form below, complete the form in its entirety and return via the link in the blue box at the bottom of the page, by fax at 301-480-9982, or by mail to:
The Health Information Management Department
10 Center Drive, MSC 1192
Bethesda, MD 20892
Minor patients, between the ages of 13-17, can request their own account in the NIH Clinical Center FollowMyHealth® Patient Portal. In order to obtain an account, please select the Minor Patient Account Form below, complete the form in its entirety and return via the link in the blue box at the bottom of the page, by fax at 301-480-9982, or by mail to:
The Health Information Management Department
10 Center Drive, MSC 1192
Bethesda, MD 20892
Please contact the Patient Portal Support Team for additional assistance. They can be reached at 1-855-644-6445, Monday through Friday (except federal holidays) 7:00 am to 5:00 pm EST.
Authorization for Electronic Communications
Authorization for Electronic Communications (Spanish)
Minor Patient Account Form (Spanish)
Authorization for Release of Medical Information