- Patient Registration Packet (PDF)
Includes HIPAA Privacy Notice and Patient Rights & Responsibilities
- Pre-Registration Paperwork (PDF)
Compete and bring with you to the office for your appointment
- Bundled Surgical Package Disclaimer (PDF)
- Election to Self Pay (PDF)
- Independent Contractors (PDF)
- Nondiscrimination and Accessibility (PDF)
- Surprise Medical Bills (PDF)
An advance directive is a document that allows a person to give instructions about medical care should they be unable to participate in health care decisions due to serious illness or incapacity. The most common types of these patient forms are living wills and power of attorney forms for healthcare. Both living wills and durable powers of attorney for healthcare are recognized by Nebraska state law.
If you have an advance directive, please bring a copy with you on the day of surgery. OSSC maintains the policy not to honor advanced directives in a life-threatening emergency and will perform life-saving techniques at that time. However, a copy of the patient registration form will be transferred to the acute care facility with you in the event of a life-threatening emergency.
For more information, contact:
Department of Health & Human Services – State Unit on Aging
P. O. Box 95026, Lincoln NE 68509-5026
Phone: 1-800-942-7830 or Fax: (402) 471-4619.