Patient Information
What information do I need to bring with me to the Hospital?
Patients should bring the following information when registering:
• Insurance Card
• Medicare/Medicaid card
• Name and Social Security Number of insured
• Referral forms from your physician (if required by your insurance carrier)
• Referral/Order Guidelines
• Worker’s compensation information (if applicable)
• Driver’s license
• Co-pay or deductible
• Pre-admission form (if not previously submitted)
If I need medical attention but cannot afford to pay for it, what can I do?
No one is turned away from MCH&HS needing emergent/emergency care because of inability to pay. We direct patients to the Financial Counselor’s office who will work with you to develop a payment plan, help you apply for Medical Assistance or, if you qualify, arrange for free care. The Rural Health Clinic and Walk-in Clinic ask patients for a $50 copay if you are self-pay.
Can I fill out any of the required paperwork before I get to the hospital?
Yes. To view all hospital forms that are available on this web site that may be printed and completed in advance of your visit, go to the Patient Information section of this web site by clicking here.
What is an Advanced Directive?
An advance healthcare directive, also known as living will, personal directive, advance directive, medical directive or advance decision, is a legal document in which a person specifies what actions should be taken for their health if they are no longer able to make decisions for themselves.
Where do I check in for Surgery?
You will check in at the Specialty Clinic which is located in the center of our hospital on the main floor. You can enter from either the main hospital entrance (door #1) or the Blair Clinic entrance (door #3) and get to the specialty clinic desk by following the wayfinding signs.
How do I choose a new primary care physician?
To choose a new primary care physician:
• Determine which providers are in network for your insurance.
• Review provider biography’s on our website or in our provider directory, you can also ask family or friends for recommendations.
• Schedule an appointment to meet the provider you are interested in by calling 402-426-4611. Make a list of questions you want to ask and bring this to the appointment. At your appointment, discuss your past medical history and that you are interested in establishing a primary care relationship.
How do I use the Walk-in Clinic?
Check in at the clinic registration desk during our walk in clinic hours. Tell the registration staff you are there for the Walk-in Clinic. Patients are seen in the order they are checked in. Walk-in Clinic hours are 8am-8pm Monday through Saturday and 8am to 5pm on Sundays Holiday hours are 8am to 2 pm. We are closed Thanksgiving day and Christmas day.
If I am dissatisfied, who should I contact?
Anyone with a concern should contact the Patient Concerns Support Line at 402-426-1682.
Visitor Information
What are the patient visiting hours and restrictions?
Visiting Hours for individuals other than your support person end at 8:30 p.m. or as determined on a patient specific basis. Visiting hours may be restricted during seasonal illness in the community.
Where do I park and enter?
Door #1- Radiology (X-ray, Ultrasound, CT, MRI), Blood draws, Specialty Clinic
Door #2- Emergency Room
Door #3- Blair Clinic, Walk-In Clinic, and closest to the Specialty Clinic
Door #4- Therapy Services (PT, OT, and Speech)
May I take flowers or gifts to a patient at MCH&HS?
Yes.
Do I need a visitor pass?
No, visitors do not need a visitors pass.
How many visitors can come at one time?
As a patient, you have the right to choose who visits you. The hospital may not exclude a visitor unless that persons’ presence disturbs you or another individual’s rights, privacy, safety or the visit is not advised for medical or therapeutic reasons. You may request that any visitor be escorted from your room at any time for any reason.
For your safety and benefit, your visitors must follow the instructions of hospital staff. Visitors must be free of communicable diseases and comply with infection control regulations. Your visitor must also follow posted regulations or policies regarding safety, restricted areas, parking, etc. Visitors may not engage in loud, disruptive, threatening or violent behavior of any kind.
Where is the cafeteria and what are the hours?
The cafeteria is located on the main level between the Blair Clinic and the main entrance. Please follow the signs that say “dining”.
Breakfast:
Monday – Friday: 7:30am – 10:00am
Weekends: No Breakfast
Lunch:
Monday – Friday: 11:30am – 1:30pm
Cafeteria open until 3:00pm
Weekends: 12:00 – 1:00pm
No public dinner hours.
Can my older child stay overnight when I have a baby?
An adult must accompany all children who visit the hospital. It is discouraged for an older child to stay overnight, please discuss with nursing staff on an individual basis. You may call the Labor and Delivery Unit to discuss your family’s needs at 402-426-1153.
Can a pet come and visit a patient?
Yes, a pet may visit under special circumstances, such as patients with a prolonged hospitalization or End of Life care due to terminal illness. Pet visitation will be limited to cats and dogs only. Current Rabies vaccination is required. Visits are pre-planned with the patient’s primary nurse and a visitation agreement will need to be completed. Pet visitation is limited to a maximum of 2 hours. MCH&HS reserves the right to deny pet visitation if the pet is deemed unsuitable to the hospital environment.
What is the Observation Unit/Skilled Care?
The Observation Unit cares for patients whose condition needs to be monitored for an extended time—up to 23 hours—to determine if it is necessary to admit the patient as an inpatient.
Skilled Care is providing rehabilitation for patients that do not require long-term care services. It is more temporary to solve a specific medial need.
How can I contact a patient?
Please contact the Medical Surgical Unit at 402-426-1125 and ask to speak to the patient.
What hotels are nearby?
There are two hotels in Blair, the Super 8 and Rodeway Inn. Other options include motels and one Bed and Breakfast. Omaha and Fremont have a variety of hotels 20+ miles away.
Department Phone Listings
Where do I call to find out the condition of a patient in the hospital?
Please call 402-426-1125 to find out the condition of a patient. Media inquiring about a patient must go through our Public Information Officer at 402-426-1464.
Where do I call if I have a question about my hospital or clinic bill?
Please call the billing department at 402-426-1255.
Medical Records
What is the Health Information Management Department?
Health Information Management improves the quality of health care by insuring that the best information is available to make healthcare decisions. HIM professionals manage healthcare data and information resources. The profession encompasses services in planning, collecting, aggregating, analyzing, and disseminating individual patient and aggregate clinical data. It serves the healthcare industry including: patient care organizations, payers, research and policy agencies, and other healthcare related industries.
How can I get a copy of my medical records for myself or to be sent to someone other than myself, such as a physician, attorney, insurance company or any other person?
Patients may inspect, obtain copies of, or have copies of their medical records sent to another health care provider or other individual. Memorial Community Hospital & Health Systems are required under state and federal laws to obtain a complete and properly executed Release of Medical Information form before they may provide a copy of a patient’s records to anyone. In the event the patient is unable to execute the authorization, the patient’s legal representative may authorize the release of information.
To obtain medical records from Memorial Community Hospital & Health Systems please go to Services, Medial Records and download Consent to Release of Information Form.
When completing the authorization form:
- Indicate the dates of treatment for which you are requesting
- The type of records (use the appropriate check boxes)
- Be sure to check the appropriate boxes if requesting information regarding: Alcohol/Drug Abuse, Mental Health, HIV/AIDS related information (this information cannot be released without specific authorization)
If the patient is a minor, 18 or younger in Nebraska, or 17 years or younger in Iowa, the authorization must be signed by a parent or his/her legally qualified representative. Proof of legal representation will be required.
While patients may request their entire record, our experience has shown that information in documents such as the Discharge Summary, Operative Report and History and Physical contain the information that most patients are seeking. For clinic records, usually the last 2 years is sufficient for most requests.
Fees
Nebraska Revised Statute 71-8404
- A provider may charge no more than $20.00 as a handling fee
- No more than $0.50 per page as a copying fee.
- A provider may charge for the reasonable cost of all duplications of medical records which cannot routinely be copied or duplicated on a standard photocopy machine.
- A provider 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.
- If the reproduction charges are greater than $100, pre-payment will be required.
- Records provided for another medical facility or physician office will have fees waived.
Submitting the request
Complete and sign the appropriate medical records request form listed above, and submit it by mailing, emailing or faxing.
Mail
Memorial Community Hospital & Health Systems — Release of Information
810 N 22nd
Blair, NE
Attn: Medical Records
Fax
(402) 426-1165
You can also bring the signed Authorization Form to
Memorial Community Hospital & Health Systems (MCH&HS) — Health Information Management Department
Hours: Monday through Friday, 8 a.m. – 5 p.m.
You may also drop off your release form at any MCH&HS location.
Inspecting or requesting a copy of your medical records
You may only inspect records at the facility location
To schedule an appointment to inspect your MCH&HS records, please contact the Health Information Management Department. A photo ID will be required.
Processing time for copies of your records
Please allow 30 days for your request to be processed. You will be notified when your records are ready.
Picking up your requested medical records
If you plan to come to MCH&HS to pick up your records, please bring a photo ID.
How can I get a copy of my child’s birth certificate and social security card?
Order Official Nebraska Birth Certificates Online From Nebraska Vital Statistics.
https://www.vitalchek.com/birth-certificates/nebraska/nebraska-vital-statistics
While I am waiting for the birth certificate to be processed by vital records, how can I obtain a verification of birth letter for my insurance?
MCH&HS can provide you with a copy of the Face Sheet- usually the first sheet in a patient’s medical record; includes patient’s name, date of birth, address, phone number, employer and insurance information; also known as a summary sheet or identification sheet.
Can I get my lab results over the phone?
Rural Health Clinic patients may receive results over the phone if the test was ordered by one of our providers. Results must be reviewed by the provider before they will be released to patients. Results can also be viewed on MyChart.
How do I obtain a copy of my Imaging Study (radiology film, x-ray, MRI, CT, ultrasound, nuclear medicine, etc)?
To obtain films, contact the Radiology Department at 402-426-1116. They will require your name and date of birth to confirm your identity and locate your exams within the hospital computer system. Please be prepared with the date(s) and exams(s) for which you are requesting copies. MCHHS digitally stores most radiology images so your images can be provided to you on CD relatively quickly. A photo ID must be presented at time of pick-up. Upon arrival at the hospital, proceed to the information desk and they will call radiology to bring the CD out to you. It is a short distance from the main entrance of the hospital and is open Monday-Friday from 7:00am to 5:00pm.
Can I fill out any of the required paperwork before I get to the hospital?
Yes. From this site you can complete, in advance, any of the following forms that are applicable to your visit. To see all hospital forms available online, please click here.
Billing
How does hospital billing work?
Hospital billing is complex which is based on many factors that includes, but is not limited to, staffing, equipment use, and the differences in the care needed by each patient. Additionally, hospitals are staffed with doctors, nurses and high tech equipment around the clock for illness or injury, from a twisted ankle to a major accident. Every patient’s case is special and requires different levels of care.
If you have a billing question or concern, please call 402-426-1255.
Can I pay a bill in installments?
Please contact the Financial Counselor, if you would like to set up a payment plan.
Call 402-426-1255, prompt #5.
Volunteering
How do I volunteer for the Hospital?
To volunteer for the hospital, please call the Administrative Assistant at 402-426-1502.
What are the volunteer opportunities?
Volunteers for the hospital work at the front desk as a greeter for our patients and visitors. Shifts at the front desk are 7am-11am and 11am-3pm. There are other events and volunteer opportunities available throughout the year through the MCH Auxiliary as well. To volunteer for the Auxiliary Thrift Shop or Rummage Sale, please call 402-426-2030.
I’m a student, how do I go about shadowing?
Please call the Community Development Coordinator at 402-426-1494 to coordinate.
