The documents below can be submitted to Health Information Management to request the release of your medical records. Please be aware that whomever you give your health information to must be responsible for securing it.
To protect your health information, the release forms must be either mailed or faxed:
CHI Health St. Elizabeth
Health Information Management, Release of Information
555 South 70th
Lincoln, NE 68510
Fax: (402) 219-7289
We will respond to your request within at least 30 days. The Health Information Management office is open from 7 a.m. – 5 p.m., Monday through Friday. Patients can call (402) 219-7141 with any questions.
Authorization for Use or Disclosure of Health Information form to another person