Notice of Data Security Incident.
CHI Health provides you, or your authorized representatives, several options for accessing your health information:
Download, print and complete the “Authorization for Use or Disclosure of/Access to Protected Health Information” form (to authorize disclosure of records to another person or organization) or “Patient Access Request to Their Protected Health Information” form (to request access to own records). If questions on completing the form, contact the hospital Release of Information representative at the below phone number.
Authorization for Use or Disclosure of/Access to Protected Health Information Form
Patient Access Request to Their Protected Health Information Form
Amendment to Protected Health Information
Submit the completed authorization form or access request form to the hospital at which you were treated by mailing or faxing:
CHI Health Creighton University Medical Center - Bergan Mercy
Attn: Health Information Management (Release of Information)
7500 Mercy Rd
Omaha, NE 68124
Phone: (402) 398-6803
Fax: (402) 398-6016
CHI Health Good Samaritan
Attn: Health Information Management (Release of Information)
10 E 31st St
Kearney, NE 68847
Phone: (308) 865-7945
Fax: (308) 865-2926
CHI Health Immanuel
Attn: Health Information Management (Release of Information)
6901 N 72nd St
Omaha, NE 68122
Phone: (402) 572-2097
Fax: (402) 572-2054
CHI Health Lakeside
Attn: Health Information Management (Release of Information)
16901 Lakeside Hills Ct
Omaha, NE 68130
Phone: (402) 717-8041
Fax: (402) 717-8040
CHI Health Mercy Corning
Attn: Health Information Management (Release of Information)
603 Rosary Dr
Corning, IA 50841
Phone: (402) 717-1792
Fax: (402) 717-0032
CHI Health Mercy Council Bluffs
Attn: Health Information Management (Release of Information)
800 Mercy Rd
Council Bluffs, IA 51503
Phone: (712) 328-5924
Fax: (712) 328-5932
CHI Health Midlands
Attn: Health Information Management (Release of Information)
11111 S 84th St
Omaha, NE 68046
Phone: (402) 593-3336
Fax: (402) 593-3353
CHI Health Missouri Valley
Attn: Health Information Management (Release of Information)
631 N 8th St
Missouri Valley, IA 51555
Phone: (402) 717-1792
Fax: (402) 717-0032
CHI Health Nebraska Heart
Attn: Health Information Management (Release of Information)
7500 S 91st St
Lincoln, NE 68526
Phone: (402) 219-7568
Fax: (402) 219-7289
CHI Health Plainview
Attn: Health Information Management (Release of Information)
704 N 3rd St
Plainview, NE 68769
Phone: (402) 717-1792
Fax: (402) 717-0032
CHI Health Schuyler
Attn: Health Information Management (Release of Information)
104 W 17th St
Schuyler, NE 68661
Phone: (402) 717-1792
Fax: (402) 717-0032
CHI Health St. Elizabeth
Attn: Health Information Management (Release of Information)
555 S 70th St
Lincoln, NE 68510
Phone: (402) 219-7731
Fax: (402) 219-7289
CHI Health St. Francis
Attn: Health Information Management (Release of Information)
2620 W Faidley Ave
Grand Island, NE 68803
Phone: (308) 398-5506
Fax: (308) 398-5699
CHI Health St. Mary's
Attn: Health Information Management (Release of Information)
1301 Grundman Blvd
Nebraska City, NE 68410
Phone: (402) 873-8922
Fax: (402) 874-5201