Forms

Name: Capital Medical Clinic Family Practice Medicine
Address: 4701 Normal Blvd, Lincoln, NE, 68506, US
Telephone: https://www.capitalmedicalclinicllp.com/wp-content/uploads/2021/09/logo-1.png
Price range: -

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

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

Please call us with any questions

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

Forms

Helpful links and information

Please call us with any questions

Helpful links
and information