There is no charge for sending medical records directly to another medical facility or doctor.
If records are requested for personal reasons, a fee may be charged.
To submit your request:
1. Download this release of information authorization form, and fill it out:
2. Submit the completed form to us
Email it to: firstname.lastname@example.org;
Fax it to: 402.559.6200;
Or mail it to:
Health Information Management– Release of Information
989100 Nebraska Medicine
Omaha, NE, 68198-9100
3. Please note
- Your authorization to release your records is valid for 12 months from the date you signed this form
- This form must be filled out completely. If it’s not completed, your request can’t be processed and will be returned
- When you submit your request, please included detailed information for how you want to receive your records
This process may take up to three business days after the request is received.
For records sent by mail, please allow 7 to 10 days delivery time.
Requests for records from before 1999 may take longer to process.
Requesting records for someone else
If you’re requesting medical records for someone else, you must also include the following documents in your request:
- Proof of legal authority to act on behalf of the patient
- Legal proof includes guardianship papers, power of attorney papers, personal representative papers and other legal documents
- Signature of the patient’s representative and date
- Relationship of representative to the patient
If you need help, please call 402.559.4024.
We are open Monday through Friday, from 8 a.m. to 5 p.m.
If you call outside of business hours, please leave a voicemail. We will return it during the next business day.