Patient Information Only - CHI Health, Nebraska (NE) - Southwest Iowa (IA)

Patient Information Only

Renewal Process

Non-employees that have been with CHI Health for over a year are required to update their information with the renewal information below.

Step 1
Renewal Form

Step 2

Fax or email all to 402-717-1995 or nonemployees@alegent.org
Packets must be sent assembled and sent in fax or email together.

Questions or Concerns?
nonemployees@alegent.org
Phone: 844-717-6947
Fax: 402-717-1995

Who would this include?

  • Offsite Conifer
  • Offsite Med Synergy
  • Non-Employed Physician Clinic Staff
  • Request for Remote Access only

The Process

Step 1

Please print, complete, and sign each of the following required documents in the packet below.

Please print, complete, and sign each of the following required documents in the packet below.
Step 1

Email or Fax all completed paperwork from above to nonemployees@alegent.org or 402-717-1995.

Your CHI sponsor also needs to complete paperwork and send to HR to complete your process. Make sure to communicate with your sponsor that you have sent your packet to HR.

All documents must be assembled into one fax or email and sent CHI Health HR. Incomplete applications are not accepted and not held on file.