• (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

MVA Payment Form

HIPPA Compliance Form

MVA and PI Policy

FAA Forms

FAA Patient Information Form

Airmen Obstructive Sleep Apena (OSA) Report

Airmen Diabetes Status Report

FAA instructions for MedXPress

Airmen Hypertension Status Report

Acceptable Diabetes medications

Airmen Hypothyroidism Status Report

Airmen Asthma Status Report

Primary Care Physicians

12728 Augusta Avenue Omaha, NE 68144

Office Hours:
Monday – Thursday 8:00 a.m. – 5:00 p.m.
Friday 7:30 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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