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Medical Interpreter Waiver Form

Obtain the waiver form from hospital staff

  • CyraCom has the waiver form. Ask the interpreter to sight translate/read it to the patient in their primary language.
  • Waiver form is invalid if completed without a professional medical interpreter.
  • Staff must document interpreters identification number on waiver form and in One Chart.

Monday – Friday

8 a.m. to 4:30 p.m.

Call 402-559-8697

Saturday and Sunday

8 a.m. to 4:30 p.m.

Page 402-888-0646

After Hours and Holidays

Use blue CyraCom phone or standard phone with dial direct instructions for assistance.


Other Languages Waiver Form

  • Use blue CyraCom for other non English patients

Deaf / ASL Waiver Form