• (402) 330-1410
  • 12728 Augusta Avenue Omaha, NE 68144
Primary Care Physicians
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Patient Forms

New Patient Information

Record Release Form

New Patient Summary Sheet

HIPAA Compliance Form

MVA and PI Policy

FAA Forms

FAA Patient Information Form

FAA instructions for MedXPress

Airmen Hypertension Status Report

Airmen Hypertension Status Report

Detailed Clinical Progress Guidelines

Airmen Hypothyroidism Status Report

Airmen Hypothyroidism Status Report

Detailed Clinical Progress Guidelines

Airmen Asthma Status Report

Airmen Asthma Status Report

Detailed Clinical Progress Guidelines

Airmen OSA Report

Airmen Obstructive Sleep Apena (OSA) Report

 

 

 

 

OSA Status Report

 

Detailed Clinical Progress Guidelines

Airmen Diabetes Status Report

Airmen Diabetes Status Report

Diabetes or Hyperglycemia on Oral Med Status Report

Detailed Clinical Progress Guidelines

Airmen Chronic Kidney Disease Status Report

Airmen Chronic Kidney Disease Status Report

Primary Care Physicians

12728 Augusta Avenue Omaha, NE 68144

Office Hours:
Monday – Friday 8:00 a.m. – 4:00 p.m.
Saturday: CLOSED

Appointments: (402) 330-1410 Ext. 0

Insurance / Billing Office: (402) 330-1410 Ext. 3305

Fax Number: (402) 330-4294

After Hours: (402) 354-2707

 

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