请求您的医疗记录

Being able to provide an accurate account of your medical history is an important aspect of individual and family health care. 例如，事实上，许多常见的疾病(如.g. diabetes, heart disease, mental illness, osteoporosis and cancer, to name a few), are congenital in nature.

通过与你的初级保健提供者分享你的医疗信息, 你提高了他或她给你最好的医疗保健的能力. 你的病史的一个重要部分是获得准确和完整的医疗记录.

Box Butte General Hospital (BBGH) and Greater Nebraska Medical and Surgical Services (GNMSS) Alliance, Hemingford, Hyannis have a release form that you can use to request your medical records from BBGH's Health Information Department or GNMSS. 请按以下连结取得表格:

Acrobat Reader will allow you to complete most of the form's required information on your computer. However, 你必须列印表格，并把表格带到博克斯比特综合医院或GNMSS签署, dated and witnessed. 将不允许您将表单保存到您的计算机, 因此，在打印之前，请确保您的信息是正确的. (提示:为了在打印表单之前更好地查看需要信息的字段, click on the "Highlight Fields" button located in the top right corner of the Acrobat Reader window. 还可以使用tab键从一个字段导航到下一个字段.)

If your request for a copy of your medical records is for personal use there is a $20 handling fee, 如果超过两页，每页收费50美分. 如果医疗记录的请求是针对医疗保健提供者的，则不收费.

Contact Information:

Julie Sheldon, HIM Manager

jsheldon@hzjly.net

308.761.3397

玛丽·古德尔，信息发布专家

mgoodell@hzjly.net

308.761.3423