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  • Address: 4701 Normal Blvd, Lincoln, NE 68506
  • Phone: 402-488-5050
  • Fax: 402-488-5001
  • Business Hours : Monday - Friday, 8:00am - 5:00pm
 
Capital Medical Clinic
  • Home
  • Our Providers
  • Forms and Links
  • Covid-19
  • No Surprises Act

Forms

  • Patient Medical History Form

  • Patient Insurance Information Form

  • Acknowledgement of Privacy Practice Notice

  • Authorization to Release Private Health Information

  • Medical Records Release Form

  • Workman's Compensation Insurance Form

  • Motor Vehicle Accident Insurance Information Form

  • Consent Form for Preauthorization to Treat a Minor

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Helpful links
and information

  • Please click here for Notice of Privacy Practices Rule Changes

  • What happens at my Medicare Annual Wellness Visit??

  • We participate with the UniNet Network.

https://www.goodrx.com/
Your Guide to Medicare Preventive Services
Medicare & You 2023
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Please call us with any questions

402-488-5050 (Call Direct)
402-488-5001 (Fax Direct)

Capital Medical Clinic

  • Address: 4701 Normal Blvd, Lincoln, NE 68506
  • |

  • Phone: 402-488-5050
  • |

  • Fax: 402-488-5001
  • |

  • Business Hours: Monday - Friday, 8:00am - 5:00pm
  • Home
  • Forms and Links
  • Covid-19
  • No Surprises Act

Please follow our page to keep in touch with changes and updates.

© 2023, Capital Medical Clinic. All Rights Reserved.
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