Forms - CHI Health, Omaha, Nebraska (NE)
FAX: 402-717-5252
 ARUP Consult
 ARUP Consult - Mobile

To order lab supplies, please choose one of the following:

To add a test

An Advance Beneficiary Notice form is submitted if patient is of Medicare age, does not have an approved diagnosis, and therefore must pay the test's cost out-of-pocket. The physician's office completes this form and the patient must sign it prior to the test.

Below is a partial list of approved Alegent Health Reference Laboratory Requisitions and instructions for completing them. When these requisitions are presented to the patient service centers (PSC) and the Diagnostic Centers (DC) the patient will receive reference laboratory pricing.

Alegent Creighton Health manual lab requisition examples and instructions for completing them.

Lead, Urine, Alpha Fetoprotein, Quad Screen forms

If you have any questions about forms please call (402) 717-5227.