Tri Valley Health System
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Patient Resources

MAKE A PAYMENT
PATIENT FORMS
To enhance your experience with Tri Valley Health System we have provided online patient resources to provide information about our programs, make online payments and request copies of your medical records.

To book an appointment, please contact us at 308-697-3329.
TVHS Entrance
 
 

​Online Payments

If this is your first time accessing the online payment portal, please contact us at (308) 697-1855 and ensure we have your email address on file.  If you have questions about payment processing on the portal after you are enrolled please contact us at (308) 697-3155 or patientportal@trivalleyhealth.com

Requesting Copies of Your Medical Records

To request copies of your medical records from Tri Valley Health System you may print the Release of Information form, complete it, and fax it to 308-697-4176 or mail to:

Tri Valley Health System 
Health Information Management
PO Box 488
Cambridge, NE 69022


If you have questions or would like a copy of the authorization form mailed to you, please call 308-697-1855 Monday through Friday 8 a.m.-5 p.m. and request the Medical Records Department.

​​Patient Forms

Allergy Consult
    Patient Family Questionnaire
    Medical History
Medicare Wellness Questionnaire
​Walk-In Clinic Intake Form
Health History Form
Release/Permission for Treatment of a Minor
DOT Physical Form
ROI Authorization Form

NSAA Physical Evaluation Form

Nebraska School Activities Association (NSAA) Preparticipation Physical Evaluation (Note: This form is to be filled out by the patient and parent prior to seeing the provider.)
Testing
 

Privacy Policy

Tri Valley Health System's full Notice of Privacy Practices. 

Patient  Information 

Forms 
​Medical Records Requests
​Patient Resources
Online Payments
​Community Health Needs
Notice of Nondiscrimination
​Site Map
Price Transparency 

Careers

Contact Us

1305 Highway 6&34
Cambridge, NE 69022
​1-308-697-3329
​info@trivalleyhealth.com

Privacy Policy

​© Tri Valley Health System

Picture
  • Home
  • About
    • The Pulse
    • Our Philosophy
    • Leadership
    • Community Health Needs Assessment
    • Tri Valley Medical Foundation >
      • Pro AM Golf Tournament
      • Scholarship Opportunities
    • Volunteer Services
    • COVID-19
    • Current News
  • PROVIDERS
    • Providers
    • Specialists
  • Services
    • Advanced Wound Care
    • Allergy Clinic
    • Cardiopulmonary
    • Imaging Services
    • Laboratory Services
    • Respiratory Therapy
    • Cornerstone Café
    • Diagnostic Sleep Center
    • Hospital Services >
      • Acute Care
      • Anesthesia
      • Emergency Services
      • ePharmacy
      • Surgical Services
      • Swing Bed
    • Maternity Services
    • Medical Clinics
    • Nutrition & Diabetes
    • Public Transportation
    • Rehabilitation >
      • Occupational Therapy
      • Physical Therapy
      • Speech Language Pathology
    • Assisted Living
    • Senior Life Solutions
    • Social Services
    • Telehealth
    • Heritage Plaza
    • Wellness Center
  • Careers
  • Patient
    • Patient Portal
    • Patient Services
    • Financial Services
    • Financial Assistance
    • Medical Record Request
    • Price Transparency
    • Forms
    • Privacy Policy
    • Gift Shop
    • Send a Smile
    • The DAISY Award
  • Contact Us
  • Patient Family Advisory Council
  • Locations
  • Charitable Donation Request
  • Online Payments
  • Visitor Guidelines
  • Community Resources