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Medical records

CHI Health provides you, or your authorized representatives, several options for accessing your health information:

Request your information from the hospital or clinic where you received care (please see instructions below).
View portions of your medical information via MyChart.
Use another application to access your health information.
- Currently available is the Health app, which is offered by Apple Inc. for iPhones with iOS version software 11.3 or greater. You will recognize it easily by the heart image. The Health app consolidates all of your health data from iPhone, Apple Watch, and third-party apps you already use, so you can view all your progress in one convenient place. This includes your health records from CHI Health and other health systems if you choose to add to add them. To get started:
  - You will need to first set up a portal account with MyChart.
  - The username and password you choose will be the security component for your health information and make it possible for you to access and import it.
  - Please note: we reserve the right to disable a third-party application, if needed. That application’s terms of use will apply and we will not have the control or ability to secure the data you place within that system.

Complete authorization form or patient access request form

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

Medical records request and authorization

Patient access request to their protected health information form

Patient access request

Amendment to protected health information

Patient request an amendment to protected health information

Fees

There is no charge for records sent directly to a provider or other health care facility for the purpose of continuing care.
If requesting records for personal or other use, a fee may be charged. Please contact the facility at the above phone number for information.

Processing your request

In most cases, record copies are available in less than a week, however some requests may take longer to process.
If you have questions or need to verify the status of your submitted request, please contact the facility at the above phone number.

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

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:

Bring to the clinic to submit for processing
Fax the form to (402) 818-1567 Attn: CIOX Health
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 [email protected].

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.