Requesting your Medical Records

Being able to provide an accurate account of your medical history is an important aspect of individual and family health care. For example, it is a fact that many common forms of illnesses (e.g. diabetes, heart disease, mental illness, osteoporosis and cancer, to name a few), are congenital in nature.

By sharing your medical information with your primary care giver, you increase his or her ability to give you the best possible health care. A vital part of your medical history is obtaining accurate and complete medical records.

Box Butte General Hospital (BBGH) and Greater Nebraska Medical and Surgical Services (GNMSS) Alliance, Hemingford, Hyannis have a release form that you can use to request your medical records from BBGH's Health Information Department or GNMSS. The form can be obtained by clicking on the link below:

Acrobat Reader will allow you to complete most of the form's required information on your computer. However, you must print out the form and bring it to Box Butte General Hospital or GNMSS to be signed, dated and witnessed. You will not be allowed to save the form to your computer, so please be sure your information is correct before printing it out. (Hint: To better see fields where information is required before printing the form, click on the "Highlight Fields" button located in the top right corner of the Acrobat Reader window. You can also navigate from one field to the next by using your tab key.)

If your request for a copy of your medical records is for personal use there is a $20 handling fee, along with 50¢ per page if more than two pages. There is no charge if the request for medical records is for a health care provider.

Contact Information:

Julie Sheldon, HIM Manager

jsheldon@ktibm.com

308.761.3397

Mary Goodell, Release of Information Specialist

mgoodell@ktibm.com

308.761.3423