Portal Registration Summary

Tell us about yourself

*First Name:

*Last Name:

*Email:

The specified email address already exists, and has previously been used on an account that is presently inactive. Please use a different email address, or contact our customer service department to re-activate this account.

*Phone:

Mobile:

*required

*Type of User:

*User Type Desc:

*Relationship to Patient:

*Facility:

*Service Partner:

*Patient DOB:

Job Title/ Credentials:

*Description:

Due to HIPAA Privacy Laws, we require a signed registration form on file prior to account activation. Click here for form
http://www.bluestonemd.com/wp-content/uploads/2014/05/Community-Staff-Bridge-Registration-Updated-06.2015.pdf Fax your completed form to: .

Please note, due to HIPAA Privacy Laws, Bluestone requires Medical Power of Attorney or Health Care Directive paperwork be on file prior to account activation. These forms can be faxed to or mailed to 270 Main Street N, Suite 300, Stillwater, MN 55082.
*For MN Health Care Directive forms and information.
www.mnaging.net/en/Advisor/HealthCareDirective.aspx

After your successful registration on Bluestone Bridge, an administrator will review your registration, and contact you to verify your association with the selected Service Partner agency.
Please be sure to include accurate phone and email contact information in your registration.

*required

Bluestone Bridge: Your secure, online health communication portal

Should you register for portal access?