Health Information Management
Medical Records
Hours of Operation
Monday through Friday
8:00AM to 5:00PM
Tel: (308) 537-3661, option 3
Fax: (308) 537-4098
How to request Gothenburg Health medical records
Gothenburg takes great care to ensure your health information is kept private and secure. If you need copies of your medical records for yourself or a third party, we can help.
To request your records from Gothenburg Health (including radiology reports and images) download, fill out, and sign the form below. Be sure to include the dates of service. Without that information, the request cannot be completed.
Download Authorization for Disclosure of Health Information Form
Authorization for Disclosure of Health Information Form
Please read the forms carefully before you sign them and be aware that whoever you give your health information to must be responsible for securing it.
Submit forms by mail or fax
Once you have completed the form, email, mail, fax, or deliver in person to:
Email:
HIM_ROI@gothenburghealth.org
Mail:
Gothenburg Health
HIM Department
PO Box 469
Gothenburg, NE 69138
Fax:
308-537-4098
Deliver in person:
910 20th Street, Gothenburg
Pay for records
There is no cost for medical records if they are sent to another health provider for continuity of care. If medical records are requested for legal or insurance purposes Gothenburg Health will charge according to the HIM fee schedule.
Receive your records
Requests for medical records are processed within 7-10 business days of receipt. Delivery of medical records to the requester may vary based on the number of requests received.
Contact us
If you have questions about requesting Gothenburg Health medical records, please call 308-537-3661 to speak with a member of our team.
