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e
Vet
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e
Vet user profile.
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IDENTIFICATION
Title:
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First Name
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:
Middle Name:
Last Name
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:
Suffix:
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IV
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Alias:
Social Security Number
(
*
This is required information for VA Patients)
First 3 SSN Numbers
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Middle 2 SSN Numbers
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Last 4 SSN Numbers
Confirm Social Security Number
(
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This is required information for VA Patients)
Confirm First 3 SSN Numbers
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Confirm Middle 2 SSN Numbers
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Confirm Last 4 SSN Numbers
Gender
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:
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Birth Date
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:
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Year
Marital Status
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Current Occupation:
You must provide your Social Security Number (SSN) before you can access VA Prescription Refill and future MHV features, such as electronic copies of your VA health information.
VA Patients:
In order to access these features, your identity will be verified by matching your MHV account information with your information in the VA system.
Related Links:
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Benefits for VA Patients
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RELATIONSHIP TO THE VA
Tell us about yourself.
(Check all that apply.
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At least one is required.)
VA Patient
Veteran Advocate/Family Member/Friend
Veteran
VA Employee
Health Care Provider
Other
You must indicate that you are a VA Patient before you can access VA Prescription Refill and future MHV features, such as electronic copies of your VA health information.
DONOR INFORMATION
Blood Type:
A+
A-
AB+
AB-
B+
B-
O+
O-
Organ Donor:
Your Blood Type will appear on your Wallet Card.
PRIMARY ADDRESS
Country
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:
United States
Afghanistan
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Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
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Aruba
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Slovenia
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Somalia
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Spain
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Sweden
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Tanzania
Thailand
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Tonga
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Tunisia
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Address 1
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:
Address 2:
City
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:
State:
AA
AE
AK
AL
AP
AR
AS
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DE
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HI
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Zip/Postal Code
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:
Province (if outside U.S.):
Information entered on this page is for your My Health
e
Vet account only and is not shared with the VA. If you need to update the information in your official VA record, including the mailing address for your VA prescriptions, please contact the appropriate office at your
VA Medical Center
.
CONTACT INFORMATION
My Preferred Method of Contact Is
*
:
Email (E)
Fax (F)
Home Phone (H)
Mobile Phone (M)
Pager (P)
Work Phone (W)
Email (E)
Home Phone (H):
Mobile Phone (M):
Work Phone (W):
Fax (F):
Pager (P):
Select your preferred method of contact. Your preferred method of contact will require you to enter information in the corresponding field.
HEALTH AWARENESS INFORMATION
Please send me information on the following health awareness topics:
(Check all that apply)
Eat right
Reducing alcohol consumption
Get moving
Health reminder
Smoking cessation
Post Traumatic Stress Disorder
Diabetes
Military related health care issues
Stress management
High blood pressure
Depression
Heart health
I would like to receive the selected health awareness information via email
ACCOUNT INFORMATION
User ID and Password
User ID
*
:
Password
*
:
Re-enter Password
*
:
Password Hint Questions and Answers
Question 1
*
:
What is the name of town in which you were born?
What is your favorite food?
What is your pet's name?
Who is your favorite actor, musician, or artist?
Who was your favorite teacher?
Answer 1
*
:
Question 2
*
:
What is the name of town in which you were born?
What is your favorite food?
What is your pet's name?
Who is your favorite actor, musician, or artist?
Who was your favorite teacher?
Answer 2
*
:
Your User ID:
must be unique
must contain no spaces
may be a combination of letters and numbers
must be 6 to 12 characters in length
is not case sensitive
Examples Include:
Starfish8
JESmith
1233bc
Your Password Must:
be 8 to 12 characters in length
have at least one letter and one number
have at least one special character (e.g., !, #, %)
have no spaces
be case sensitive
not be the same as the User ID
Examples Include:
#1veteran
some_pass1
giveme$100
Your Password Hint Questions:
A Password Hint is a question you will be asked to confirm your identity. It will be asked if you cannot remember your User ID or Password. Be sure to select questions and answers you will remember.
Terms & Conditions and Privacy Policy
I have read and agree to abide by the following My Health
e
Vet terms.
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Terms & Conditions
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Privacy Policy