Patient Resources


Suicide Prevention

National Suicide Prevention Lifeline: 1-800-273-8255.

Helpful websites:
13 Minutes
Suicide Prevention Lifeline
The Kim Foundation

Billing Questions

For help with your current bill, call 402-395-2191 and ask for Patient Financial Services.
For help with a bill that is past due:
     - If you got the bill before January 2, 2018, call 402-395-3268.
     - If you got the bill after January 2, 2018, call 308-398-3955.
For a loan to help pay off your medical bills, call Nancy at Cornerstone Bank 402-395-2151.
Need insurance you can afford? Call Cierra at 1-866-466-9339 to set up a time to find out your choices.

Flu "Shot on the Spot" Forms

Flu Shot Consent Form
Flu Shot for Insurance Submission Form

Sports Physical Registration

Sports Physical Consent Form

Healthcare Rights

Financial Assistance Covered Providers
Financial Assistance Policy
Financial Assistance Summary
Advanced Directives
Patient Bill of Rights
Privacy Policy
Nondiscrimination Policy

Patient Forms

Title it Sports Physical Registration Form
Financial Assistance Application
Release of Health Information Form
Patient Service Agreement Clinic - Outpatients
Patient Service Agreement Clinic - Outpatients - Spanish
Patient Service Agreement
Patient Service Agreement - Spanish

Resources

Patient/Visitor Grievance Form
Health Insurance Marketplace Authorization Form
Policies
Payment Guidelines
2015 Comprehensive Community Health Needs Assessment
Functional Needs Registry Information
Dispose of unused, unwanted, or expired medications
Creating Your Patient Portal
www.caringbridge.org
www.aseracare.com