Requesting your Medical Records

能够准确地描述你的病史是个人和家庭医疗保健的一个重要方面. For example, it is a fact that many common forms of illnesses (e.g. diabetes, heart disease, mental illness, osteoporosis and cancer, to name a few), are congenital in nature.

By sharing your medical information with your primary care giver, you increase his or her ability to give you the best possible health care. A vital part of your medical history is obtaining accurate and complete medical records.

Box Butte总医院(BBGH)和大内布拉斯加州医疗和外科服务(GNMSS)联盟, Hemingford, Hyannis有一个发布表格，您可以使用它向BBGH的健康信息部门或GNMSS请求您的医疗记录. The form can be obtained by clicking on the link below:

acrobatreader可让你在电脑上填写表格所需的大部分资料. However, you must print out the form and bring it to Box Butte General Hospital or GNMSS to be signed, dated and witnessed. You will not be allowed to save the form to your computer, so please be sure your information is correct before printing it out. (Hint: To better see fields where information is required before printing the form, 按位于acrobatreader视窗右上角的“高亮栏位”按钮. You can also navigate from one field to the next by using your tab key.)

如果您要求提供医疗记录副本供个人使用，则需要支付20美元的手续费, along with 50¢ per page if more than two pages. There is no charge if the request for medical records is for a health care provider.

Contact Information:

Julie Sheldon, HIM Manager

jsheldon@basilinfracon.com

308.761.3397

Mary Goodell, Release of Information Specialist

mgoodell@basilinfracon.com

308.761.3423