Skip to main content

Call 308-635-3711 or Contact Us

Header Top

About Your Bill
Login to MyChart

Translate this page

English
Español
French

Search

Services
Primary Care
Family Medicine
Pediatrics

Urgent, Emergent, and Trauma Care
Air Link
Emergency Medical Services
Emergency Medicine
Stroke
Trauma Services
Transfer Center
Urgent Care
Specialty Care
Acute Rehabilitation Unit
Anesthesiology
Anticoagulation Clinic
Bariatric & Weight Loss Surgery
Behavioral Health Unit
Birth & Infant Care Center
Breast Health Center
Cancer Services
Cardiology
Diabetes Care Center
Dorwart Cancer Care Center
Ear, Nose and Throat, Head and Neck Surgery
Endocrinology
Heart & Lung
Hospitalist Service
Imaging Services
Internal Medicine
Laboratory Services
Nephrology
Neurology
Neurosurgery
Oncology
Orthopaedics
Pain Management
Plastic & Reconstructive Surgery
Psychiatry & Behavioral Health
Pulmonology, Critical Care
Radiation Oncology
Rehab Center
Rehabilitation Medicine
Scottsbluff Surgery Center
Skin Clinic & Medical Aesthetic Center
Sleep Disorder & Diagnostic Clinic
Spine Center
Surgery, Vascular Diagnostics
Urology
Weight Loss Options
Women's Center
Wound/Ostomy Clinic
Patients
About Your Bill
Contact Us
Guest Relations
Medical Record Request
Pastoral Care

Patient Education & Other Resources
MyRegionalWest
MyChart
Patient & Family Responsibilities
Patient Information Guide
Patient Testimonials
Pharmacy Services
Regional West Non-Discrimination Notice
Social Work
Support Groups
We Want to Hear from You
Visitors
Driving Directions & Parking
Gift Shop
Inn Touch
Park Bench Café
Visitation Guidelines
Visiting Regional West
Ways to Give
Blood Donation
Volunteers & Friends
The Foundation
Our Board of Directors
Grateful Patient
Ways to Give
Donate Now
Scholarships
Careers
Education Opportunities
Employment
Job Shadowing at Regional West
Nursing
Recruitment
Daisy Award
Upcoming Classes

Physician and Provider Recruitment
A Taste of Our Community
An Innovative Medical Group
Remote Respiratory Therapy Programs
UNMC Medical Residency Program
School of Radiologic Technology
Academic Calendar
Admissions
Application Form
Program Accreditation
Request More Information
Tuition, Refunds, & Financial Aid
Our Network
About Us
Board of Directors
Our History
Our Leadership
A Culture of Safety
Price Transparency

Event Calendar
News
The Foundation
Regional Care, Inc. (RCI)
Regional West Connect
The Village
About Us
Assisted Living
Independent Living
Location & Directions

Quick Links

Find a Provider
New Patients Schedule Now

Breadcrumb

Home

Patient/Family Informed Consent/Assignment of Benefits/Release of Information Form

Document

patientfamily-informedconsent-assignbenefits.pdf

Facebook Instagram Linkedin

Find a Provider New Patients Schedule Now

Regional West
4021 Avenue B
Scottsbluff, NE 69361

See on Google Maps

Footer

Services
Patients
Visitors
Ways to Give
Careers
Our Network
MyChart
Provide Feedback
About Your Bill
Contact Us
Price Transparency

Connect With Us

Subscribe to Regional West News & Updates

© 2025 Regional West

Footer Bottom

Privacy & Security Policy
Disclaimer
Notice of HIPAA
Sitemap