Submit the Request
Submit the completed authorization form to the hospital at which you were treated by mailing or faxing:
CHI Health Creighton University Medical Center - Bergan Mercy
Attn: Health Information Management (Release of Information)
7500 Mercy Rd
Omaha, NE 68124
Phone: (402) 398-6803
Fax: (402) 398-6016
CHI Health Good Samaritan
Attn: Health Information Management (Release of Information)
10 E 31st St
Kearney, NE 68847
Phone: (308) 865-7945
Fax: (308) 865-2926
CHI Health Immanuel
Attn: Health Information Management (Release of Information)
6901 N 72nd St
Omaha, NE 68122
Phone: (402) 572-2097
Fax: (402) 572-2054
CHI Health Lakeside
Attn: Health Information Management (Release of Information)
16901 Lakeside Hills Ct
Omaha, NE 68130
Phone: (402) 717-8041
Fax: (402) 717-8040
CHI Health Mercy Corning
Attn: Health Information Management (Release of Information)
603 Rosary Dr
Corning, IA 50841
Phone: (402) 717-1792
Fax: (402) 717-0032
CHI Health Mercy Council Bluffs
Attn: Health Information Management (Release of Information)
800 Mercy Rd
Council Bluffs, IA 51503
Phone: (712) 328-5924
Fax: (712) 328-5932
CHI Health Midlands
Attn: Health Information Management (Release of Information)
11111 S 84th St
Omaha, NE 68046
Phone: (402) 593-3336
Fax: (402) 593-3353
CHI Health Missouri Valley
Attn: Health Information Management (Release of Information)
631 N 8th St
Missouri Valley, IA 51555
Phone: (402) 717-1792
Fax: (402) 717-0032
CHI Health Nebraska Heart
Attn: Health Information Management (Release of Information)
7500 S 91st St
Lincoln, NE 68526
Phone: (402) 219-7568
Fax: (402) 219-7289
CHI Health Plainview
Attn: Health Information Management (Release of Information)
704 N 3rd St
Plainview, NE 68769
Phone: (402) 717-1792
Fax: (402) 717-0032
CHI Health Schuyler
Attn: Health Information Management (Release of Information)
104 W 17th St
Schuyler, NE 68661
Phone: (402) 717-1792
Fax: (402) 717-0032
CHI Health St. Elizabeth
Attn: Health Information Management (Release of Information)
555 S 70th St
Lincoln, NE 68510
Phone: (402) 219-7731
Fax: (402) 219-7289
CHI Health St. Francis
Attn: Health Information Management (Release of Information)
2620 W Faidley Ave
Grand Island, NE 68803
Phone: (308) 398-5506
Fax: (308) 398-5699
CHI Health St. Mary's
Attn: Health Information Management (Release of Information)
1301 Grundman Blvd
Nebraska City, NE 68410
Phone: (402) 873-8922
Fax: (402) 874-5201
Fees
- There is no charge for records sent directly to a provider or other health care facility for the purpose of continuing care.
- If requesting records for personal or other use, a fee may be charged. Please contact the facility at the above phone number for information.
Processing Your Request
- In most cases, record copies are available in less than a week, however some requests may take longer to process.
- If you have questions or need to verify the status of your submitted request, please contact the facility at the above phone number.
CHI Health Clinics - Requesting Medical Records