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Nebraska Medicine fax number

(402) 552-2025

Employee Health

Used for: Submission of Employee Health forms (e.g., Employee Health Patient Information Form and Consent for Treatment MIS-0266; Annual TB Screening forms) to Employee Health for processing.

Fax destination details

Department
Employee Health
Purpose
Submission of Employee Health forms (e.g., Employee Health Patient Information Form and Consent for Treatment MIS-0266; Annual TB Screening forms) to Employee Health for processing.
Form
MIS-0266 — Employee Health Patient Information Form and Consent for Treatment
Address
Employee Health Department • 988444 Nebraska Medical Center • Omaha, NE 68198-8444
Voice phone
(402) 552-3563

Before you send

  • Confirm that this exact department handles your document or request.
  • Check the organization website or call its main line for the current fax number.
  • Include a cover sheet and any case, member, claim, or form reference required.
  • Keep the delivery confirmation with your submission records.

Complete patient information, provide consent for treatment, and sign; guardian signature required if patient is under 19; submit to Employee Health.

Official form instructions are published as a downloadable file on the organization's website.

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