Request Medical Records - CHI Health Clinic

CHI Health and CHI Health Clinic have partnered with CIOX Health and MediCopy Services for the release of protected health information (PHI), otherwise known as medical records. Your medical record includes, but is not limited to your medical history, diagnosis, treatment as well as lab results and reports from previous testing and procedures.

To request a copy of your medical records, we ask that you fill out an authorization. You can complete an authorization by following one of the options below. If the patient is a minor, or unable to sign an authorization, the signature of an authorized legal guardian is required. Once your authorization is submitted, please allow two business days before calling to check status.

Rural Clinics

Clarkson, Howells, Nebraska City, Plainview and Schuyler, Neb., and Bedford, Corning, Dunlap, Lenox, Logan, Missouri Valley and Woodbine, Iowa

For the clinics listed above, please use our medical records release form. Select "Other" and list the clinic from which you are requesting records. 

Submit the form one of three ways:

  1. Bring to the clinic to submit for processing
  2. Fax the form to (402) 818-1567 Attn: CIOX Health
  3. Mail the form to:
    CHI Health Medical Records
    Release of Information
    2001 S 75th St, Ste 200
    Omaha, NE 68124-2398

All Other CHI Health Clinic Locations

Request Your Records Online

To fill out an online authorization form. Your authorization will open in your internet browser. If you need to refer back to this page please right click to open in a separate tab. Please note that a valid email address is required when submitting an online authorization and to complete the submission process, you must check your email and verify your request for medical records.

Email Your Request

Please print an authorization. Once you have filled out your authorization in its entirety, you may securely email it directly to MediCopy at

Mail Your Request

Please print an authorization. Once you have filled out your authorization in its entirety, you may mail it directly to MediCopy at:

MediCopy Services, Inc.
Attn: Record Request – CHI Health Clinic
8 City Blvd., Suite 400
Nashville, TN 37209

After MediCopy receives your completed authorization, your request will be processed as quickly as possible and within 30 days as required by law.

Please note that if your records are being mailed, it may take a few additional days for them to arrive. If you have requested to have your records emailed to yourself or another entity, the provided email address will receive a secure, password protected link to your records. For security purposes, this link will expire, so please be sure to check your email regularly, and always check your spam folder!

Is there a charge for the records?

Records sent to another provider are complimentary. There is no charge to have your records emailed or faxed to you. If you request that your medical records be mailed there is a charge for postage and processing.