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[Required] Enter a username with at least 4 and no more than 32 characters. You may use letters, numbers, and the underscore character. This username will uniquely identify you on Ashe Memorial Hospital. Capitalization doesn't matter.
[Required] Enter a password with which to secure your account. Capitalization matters. To make your password more secure, use special characters (e.g., @) and mix lower and uppercase. The password must be at least 8 characters long.
[Required] Retype your password to ensure it was entered as you expected.
[Required] Enter the e-mail address you would like to associate with your account.
[Required] By entering these characters you help prevent fake registrations. Capitalization doesn't matter. Click on the refresh icon to get new characters if the current ones are too difficult to decipher.
[Required] By answering this math problem you help prevent fake registrations.
[Required] Select a security question from the list. This will be used in case you forget your username or password.
[Required] Make sure your answer is memorable to you but hard for others to guess. Capitalization doesn't matter.
[Required] Select a security question from the list. This will be used in case you forget your username or password.
[Required] Make sure your answer is memorable to you but hard for others to guess. Capitalization doesn't matter.
[Required] Enter the first name of the patient. If you are acting as the legal custodian for a patient (e.g., a parent for a minor child) and are signing up for Ashe Memorial Hospital to view that patient's medical information, enter the patient's first name, not yours. If you are signing up for Ashe Memorial Hospital to view your own medical information, enter your own first name.
[Required] Enter the last name of the patient. If you are acting as the legal custodian for a patient (e.g., a parent for a minor child) and are signing up for Ashe Memorial Hospital to view that patient's medical information, enter the patient's last name, not yours. If you are signing up for Ashe Memorial Hospital to view your own medical information, enter your own last name.
[Required] Enter the patient's date of birth. If you are acting as the legal custodian for a patient (e.g., a parent for a minor child) and are signing up for Ashe Memorial Hospital to view that patient's medical information, enter the patient's date of birth, not yours. If you are signing up for Ashe Memorial Hospital to view your own medical information, enter your own date of birth.
[Required] Enter the code given to you by the provider. This code is used to securely link your account on Ashe Memorial Hospital to the provider's medical records for the patient.
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