How to Obtain Medical Records from CMC Health Information Management Department
- Complete a form: AUTHORIZATION FOR RELEASE (DISCLOSURE) OF INFORMATION. This form can be printed from CMC website or you can contact the Health Information Management Department at CMC to request a paper form (402-245-6550). A properly executed release of information form should;
- Be addressed to the facility (Releaser)
- Designate the name of the person, company or agency to which the information is to be given or released to
- Specify the period of time or date of service for which information is being requested
- Be signed by the patient or legally qualified representative
- Make sure the release is dated at the time of, or after the hospital encounter for which information is being requested
- If information is for a minor (age 19 or under) an authorization must be signed by the parent and/or legal guardian in the case of a court ordered guardianship
- If information is for a deceased patient, authorization must be signed by the patient’s Power of Attorney, personal representative (the executor or administrator of the patient’s estate), spouse, or next of kin with proper identification.
- All requests for copies of medical records requires a 24 hour notice
- In some instances a fee will be charged for copies of records
How to Obtain Your Medical Records:
- Download and print this form. Alternately you may contact us at (402) 245-6550 and request a Release of Medical Records Form.
- Mail or Fax this form to: Community Medical Center
Health Information Management
3307 Barada St., P.O. Box 399
Falls City, NE 68355
If you need to obtain a copy of a legal birth certificate for a birth that occurred at Community Medical Center please visit the website: DHHS.VitalRecords@nebraska.gov or contact DHHS Vital Records Department, P.O. Box 95065, Lincoln, NE 68509-5065.
CMC cannot provide medical advice over the phone. Please contact your provider or schedule an appointment to receive test results, advice, a diagnosis or treatment.