Access PHR Plus Registration This field is hidden when viewing the formscriptCongratulations and thank you for completing your registration! Your membership benefits entitle you to create your Personal Health Records. The Access PHR Plus is a comprehensive Medical ID system that combines the features of organization and access to all your Personal Health Records. The custom engraved acrylic plate provides clear instructions to all medical responders on how to easily access this health information. In addition, the most vital information you choose is automatically added to your Emergency Medical Card which is meant to be carried with you and can be read in any emergency, with just a glance. Please complete the following information to assist us in setting up your account. Note that this is NOT necessarily the information that will become part of your Personal Health Records. When finished, please select the COMPLETE REGISTRATION button. IMPORTANT: AFTER COMPLETING THIS REGISTRATION PLEASE BE SURE TO CHECK YOUR EMAIL. IN OUR EMAIL CONFIRMATION YOU WILL FIND A LINK TO OUR ACCESS PHR TUTORIAL VIDEO. THIS HELPFUL VIDEO WILL GUIDE YOU THROUGH THE OPERATION AND USE OF THE MANY FEATURES FOUND WITHIN THE FOLDERS THAT MAKE UP YOUR PERSONAL HEALTH RECORDS. Please contact us at (800) 319-0199 or info@universalmedicaldata.com with any questions or additional support that is needed.Member ID #*Select Product to Register* Access PHR Plus Responder PHR Member Benefit (CURE SMA) IMPORTANT: The product name will be located on your Order Confirmation or the front cover of the registration instruction pamphlet included with your product packaging. Please select carefully.Today's Date Month Day Year Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Important! Name information is required for the account holder. It is not necessarily the user information on the Personal Health Record Email* Enter Email Confirm Email PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Special Requests, SuggestionsIMPORTANT: AFTER COMPLETING THIS REGISTRATION PLEASE BE SURE TO CHECK YOUR EMAIL. IN OUR EMAIL CONFIRMATION YOU WILL FIND A LINK TO OUR ACCESS PHR TUTORIAL VIDEO. THIS HELPFUL VIDEO WILL GUIDE YOU THROUGH THE OPERATION AND USE OF THE MANY FEATURES FOUND WITHIN THE FOLDERS THAT MAKE UP YOUR PERSONAL HEALTH RECORDS. Please contact us at (800) 319-0199 or info@universalmedicaldata.com with any questions or additional support that is needed.This field is hidden when viewing the formStatus Δ
