Medical Membership Parent

Thanks to a three-year grant from Blue Cross and Blue Shield of North Carolina, the YMCA is able to offer Medical Memberships to members of our community who need access to quality, evidence-based programs, health coaching and work out facilities. We're excited you have decided to join us and we look forward to following you on your health journey! Before you begin, we need you to complete a few forms and signatures. You can read the information below as an introduction into how we will use the information you provide.

Medical Membership includes participation in what is referred to as an Evidence-Based program(s), therefore we will be listed as Medical Membership in the next few pages. During your participation in an evidence based program our staff will collect pre and post measures to monitor your progress and ensure program standards. Data such as height, weight, balance measures, and physical activity measures may be collected, it will vary per program. This is the ONLY data that we review and share with health care providers. We do not have access to your personal health records. The YMCA care team members such as your instructor, health coach, coordinator, and YUSA technical advisors may have access to this data to ensure you are receiving the best-coordinated care.

The YMCA of the Triangle follows the same HIPAA policy and procedures as your physician’s office. Below is an explanation of how data is collected and secured with the highest security and confidentiality standards.

Should you have any questions or concerns, please contact Amy Ward, HIPAA Compliance Health Officer, for the YMCA of the Triangle 919-582-9396 or Amy.Ward@ymcatriangle.org.


Lets Get Started!

We recommend having the following items handy before starting:   
  ✔ Your YMCA online account information   
  ✔ Your contact information   
  ✔ Emergency Contact Information (Name and phone number)   
  ✔ Physician / Provider Information (Name, Practice, Address, Phone/Fax)Your contact information/email   
  ✔ Your insurance information* (Provider, Policy and Group #) 
      *Required for Blue Cross Blue Shield (BCBS) Participants

Not recommended.
For display purposes, we do not recommend using Google Chrome or your smartphone. You will be able to submit your information, but it will be more difficult and frustrating to navigate.


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