Noran Neurology Imaging Portal

Access Request and Agreement

By requesting access and agreeing to these terms, you affirm that you are a HIPAA Covered Entity and understand your responsibility to comply with all applicable HIPAA regulations and state privacy laws. You acknowledge that you are solely responsible for ensuring compliance with these requirements.

You agree to access only those patient records and images for which you have a direct provider–patient relationship and for which the patient has authorized disclosure to you. You further agree to maintain the confidentiality of all patient information as required by federal and state law, and you will not distribute, modify, recreate, or otherwise misuse any portion of the patient medical record.

If you violate any provision of this agreement, Noran Neurology may immediately terminate your access to its Medical Professional Imaging Portal and pursue any other remedies available under law.

I have read, understand, and agree to these terms.
 

First Name Required

Last Name Required

Credentials (e.g. MD, DO, DC, etc.)

Title

NPI Number (If you are staff, use Clinic NPI) Required

Clinic Name Required

Clinic Address Line 1 Required

Clinic Address Line 2

Clinic City Required

Clinic State Required

Clinic Zip Code Required

Clinic Telephone Required

Fax Number

Email Address (Username) Required

Please type the letters and numbers shown in the image. Click the image to see another captcha.