Your medical record is kept in Health Information. These records are retained in compliance with Health Insurance Portability and Accountability Act (HIPAA) and are not released without the patient’s written consent, except as required by law. Please allow 7-10 business days for the process of your record request. You may pick up your records between 8:00 a.m. and 4:30 p.m. Monday through Friday, excluding all federal holidays. Please bring photo identification with you. If someone is picking up the records for you, they must have written permission from you on our release forms identifying them to do so and they must provide photo identification. Please include any POA paperwork when submitting your record request for a patient that you are a guardian for.
Any STAT requests made after 4:00 p.m. will be taken care of on the following business day. There may also be charge for the cost of copying medical records.
We do not take verbal requests from patients!
Complete the form below to release your medical record to either yourself or to a third party such as an attorney, caregiver or life insurance company. The form must be signed by the individual patient, parent or guardian, or personal representative. We do require proof of guardianship and/or personal representative papers.
Please complete and return the form to:
Health Information Department (HIM)/Medical Records
Fillmore County Hospital
1900 F. Street, PO Box 193
Geneva, NE 68361-0193
Or fax form to: 402-759-3884
Or e-mail the form to: email@example.com
If you have questions, please call our Health Information Department at: 402-759-3167 and ask for Medical Records