medical records

submit a records request

1.Download the release of information authorization form, and fill it out.

2. Submit the completed form to us:

b. Fax it to: (402) 436-2086

c. Or mail it to:

Nebraska Orthopaedic Center
Attn: Medical Records
6900 A Street
Lincoln, NE 68510

3. Please Note

Your authorization to release your records is valid for 12 months from the date you signed this form.
This form must be filled out completely. If it’s not completed, your request cannot be processed.
When you submit your request, please included detailed information for how you want to receive your records.
If you are requesting Nebraska Orthopaedic Center (NOC) obtain records on your behalf from another facility, select the checkbox next to “NOC to receive records from facility” in the Release section of the form and provide the facility information to the right.

There is no charge for sending medical records directly to another medical facility or provider.
If records are requested for personal reasons, a fee may be charged. NOC may impose cost-based fees, not to exceed $0.50 (50 cents) per page in addition to a $20.00 handling fee. (Rev.Stat § 71-8404)
NOC may charge for the reasonable cost of all duplications of medical records which cannot routinely be copied or duplicated on a standard photocopy machine.
NOC may charge an amount necessary to cover the cost of labor and materials for furnishing a copy of an X-ray or similar special medical record. If the provider does not have the ability to reproduce X-rays or other records requested, the person making the request may arrange, at his or her expense, for the reproduction of such records.

This process may take up to three (3) business days after the request is received.
For records sent by mail, please allow 7 to 10 days delivery time.
Electronic receipt is the fastest method to obtain your records. You must have an active patient portal account to receive records electronically.

If you’re requesting medical records for someone else, you must also include the following documents in your request:

- Proof of legal authority to act on behalf of the patient
- Legal proof includes guardianship papers, power of attorney papers, personal representative papers and other legal documents
- Signature of the patient’s representative and date
- Relationship of representative to the patient

If you need help, please call 402-436-2000
We are open Monday through Friday, from 8 a.m. to 5 p.m.
If you call outside of business hours, please leave a voicemail. We will return it during the next business day.