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.

 

 

Online Payments

Requesting Copies of Your Medical Records

Due to the change in our hospital accounting software, we are unable to provide our customers with an online payment option at this time. Our old online payment option of Webview is no longer available as of October 31. If you had automatic payment arrangements set in webview, you will need to call us to set up a different payment option. Or if you are just needing to pay by credit card you will need to contact our patient accounting office at 308-697-3155 or 800-335-9898. We are currently working on new functionality through our patient portal that should be available very soon. We apologize for the inconvenience.

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 308-697-4918 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 308-697-3329 Monday through Friday 8 a.m.-5 p.m. and request the Medical Records Department.

​​Patient Forms

Patient Family Questionnaire

Patient Family Questionnaire (Large Print)

Medicare Wellness Questionnaire

Medical History

Walk-In Clinic Intake Form

Health History Form

Release/Permission for Treatment of a Minor

DOT Physical 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.)

 

Privacy Policy

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