A feature of the Long Island Community Hospital’s Electronic Medical Record (EMR) is the Long Island Community Patient Portal. The Long Island Community Patient Portal is a secure, online website that provides convenient 24-hour access to a portion of your own personal health information from anywhere you access the web.

Who can request access to Long Island Community Hospital’s Patient Portal?
Patients who have been admitted on or after July 1, 2014 (as an inpatient) who are 18 years of age or older and have an email address.

                                            Instructions to request access:
Step 1: Complete the attached Patient Portal Access Request form.
For your convenience the form may also be printed from the Long Island Community Hospital website:www.LICommunityHospital.org

           For Patients - Request Access to the Long Island Community Hospital Patient Portal

A. Bring the completed form, in person, to the Health Information Management (HIM) department with proper photo ID.
Note: We are open weekdays from 8:00 a.m. to 4:00 p.m.
Please stop at the reception desk in the front lobby for directions
                                                       OR
B. Mail a completed and notarized form to the Health Information Management (HIM) department:
Long Island Community Hospital
Health Information Management Department
101 Hospital Road
Patchogue, NY 11772

Step 2: Once we have processed your request for access, you will receive an email providing you with your username and a temporary password. 

Step 3: Log into your portal account by using the link below and the provided username and temporary password.https://portal.bmhmc.org/Brookhaven/Patient#/ 

Step 4: After you have successfully logged in for the first time, please change your temporary password to something more secure and answer the three security questions.
                                                   It’s that simple!

                                       Patient Portal Access Request Form
To access the Patient Portal, complete the Patient Section and:
1. Bring this form to the HIM Department in person with photo ID OR
2. Have this form notarized and mail this form to:
                                      Long Island Community Hospital
                              Health Information Management Department
                                            101 Hospital Road
                                            Patchogue, NY 11772
____________________________________________________________________________
Patient Section: 

Patient Name: ____________________________________________________________

Date of Birth: ___/____/_____ 


Last First M.I. ________________________________________________________________ 


Address:_________________________________________________________________________________________________________________ Street Address City, State Zip Code
Email Address: ___________________@______________________._______
Phone Number: (____)________________________________________________ 


By signing below, I acknowledge that the Long Island Community Portal contains Protected Health Information (PHI ). It is recommended that all users keep their portal name and password secure to prevent any unauthorized access to your PHI. It is further recommended that you change your Portal password at regular intervals to enhance privacy for the PHI contained on the Portal. 


X_____________________________________________________________

Date: _____/_____/_____ 


Signature of Patient
_________________________________________________________________

Notary Public Section:
STATE OF _________________________________________ )
SS: COUNTY OF ________________________________________ )
On this _____________ day of _____________________________________, 20____, before me personally came
_______________________________________________________________, to me know and known to me to be the person described in and who executed the forgoing instrument and he/she acknowledged to me that he/she executed the same.
___________________________________________________________
NOTARY PUBLIC
____________________________________________________________________________
For Internal Use Only:
Patient’s Medical Record Number: _______________________________________
Most Recent Inpatient Account Number: __________________________________
must be 7/1/2014 or greater

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