Welcome to our online medical records request form. This form is to be used to request copies or information from your medical record or for someone you are the legal guardian for.
Fill in the patient information and a description of what you are requesting. If you need copies of more than one patient’s medical records, you will need to fill out a different form for each patient. If you have any questions call Thayer County Health Services at 402-768-6041 during normal business hours and ask to be connected to the health information office.
You will need to attach a signed copy of a Records Release Request along with your online request. If you don’t have one here is a link to download one: Records Release Request Form
This form is just a medical records request. The Health Information office will verify the request and contact you by the method you indicated (phone or email) regarding your request.