Good Samaritan Clinic Users - CHI Health, Nebraska (NE) - Southwest Iowa (IA)
Questions or Concerns

Questions or Concerns?
Phone: 844-717-6947
Fax: 402-717-1995

Who would this include?

  • Clinic staff requesting remote access to the CHI Health St. Elizabeth

  • Office billing/coders

  • Office clinical

  • Office procedural

The Process

Step 1

Please complete the following document

Step 1

Email or Fax all completed paperwork from above to or 402-717-1995.

If you have questions regarding completion of this form, please contact your sponsor, Jan Wagner, directly.