This is a brief overview of what to expect during your office visit, as well as some of the services we provide. If you wish, it may be helpful to

bring someone with you to listen and take notes during your visit. While you are cared for by many physicians, our care for you can often times be complex. Please Call Us Early and Call Us First if you are being sent to the

ER by another physician.

ArrivalUpon arrival, our Patient Schedulers will greet you and ask for your driver’s license or current photo ID, your insurance card(s), and have you complete any necessary forms. They will scan your cards and completed patient forms into your electronic chart. They will also ask to take your picture for your chart so our medical staff can easily identify you. You will then complete the check in process.

A Medical Assistant will then greet you to obtain your vital signs and review your current medications with you. Due to potential drug interactions, it is important for you to know all of your current medications or bring the bottles with you. Please include vitamins, herbals, and over-the-counter medications. Your physician will review and complete your health history, followed by a physical exam if indicated. He/she will discuss your diagnosis and management plan. If you have any questions about your diagnosis and/or treatment, please let your physician know; we encourage you to ask questions. If your physician recommends treatment, it will be done in the treatment area of the clinic. In most cases treatment will not be started on your first visit, unless your physician has already discussed this with you.

Appointment TimeOur goal is to see our patients as close to their appointment time as possible. We strive to keep waiting times to a minimum, please realize delays can occur due to emergencies and unforeseen patient needs. If you arrive more than 30 minutes prior to your scheduled appointment time, you will be seen closer to your appointment time. If you arrive more than 30 minutes late for your appointment, you will be asked to reschedule.

Patient PortalOur practice utilizes Navigating Care. The patient portal allows convenient and secure online access to your Personal Health Record. Access gives you up-to-date information about your diagnosis, medications, and lab results.

17201 Wright Street Suite 200 Omaha, NE 68130Phone (402) 334-4773 Fax (402) 330-7463

NebraskaCancer.com

HELLO!

Welcome to Nebraska Cancer Specialists!

Please Call Us Early

and Call Us First if

you are being sent to

the ER by another

physician.

Advanced Practice Providers:At times you will be seen by an Advanced Practice Provider (Nurse Practitioner or Physicians Assistant). These clinicians have an advanced degree, allowing them to make medical decisions and order treatments/medications. They work in close collaboration with your physician.

Check-outFollowing your appointment, you will check-out with our patient schedulers, who will schedule your next appointment as well as any necessary tests or procedures recommended by your physician. Please note: Your insurance does not pay for everything, even some care that you or your health care provider have good reason to think you need.

Appointment RemindersOur practice uses an appointment and balance reminder system. You may receive an email, phone call, or text message with this information. At any point, you may opt out of these reminders.

Nurse Case ManagersRemember to Call Us Early, Call Us First! Your nurse case manager is the contact person for any questions or concerns that may arise between office visits. Our case managers are highly-trained oncology nurses with many years of oncology experience. Please leave a voicemail; calls for test results and non-urgent matters will be returned after urgent patient needs are met. For life-threatening emergencies, call 9-1-1. If you are in need of a prescription refill, contact your pharmacy directly. They will contact us for any authorization needed.

Patient Financial ServicesOur patient financial services team is here to help you! We participate with most major insurance plans including Medicare and Medicaid, and we will verify your insurance prior to your office visit. You may find it helpful to check with your insurance ahead of time to determine if our physicians are considered “in-network” for your plan. Once you and your physician have determined a treatment plan (if needed), patient financial services will verify benefits with your insurance company.

Your co-payment must be paid at the time of your office visit. Payment options include cash, check, Visa, MasterCard, American Express, and Discover. We will submit charges to your insurance company and send you a bill for any deductible and/or uncovered portion of the charges. Please note that any services such as tests and procedures that are provided outside of our office will be billed to you directly by the provider of those services. The bill you receive from Nebraska

17201 Wright Street Suite 200 Omaha, NE 68130Phone (402) 334-4773 Fax (402) 330-7463

NebraskaCancer.com

HELLO! PAGE 2

Welcome to Nebraska Cancer Specialists!

Remember to Call

Us Early, Call Us

First! Your nurse

case manager is

the contact person

for any questions

or concerns that

may arise between

office visits.

Cancer Specialists is separate from other bills you may receive from the hospital or other physicians.

Our patient financial services team is available to answer any questions you might have about reimbursement and payment. If you need assistance with your insurance requirements, we are here to help you. Please feel free to contact patient financial services at 402.537.5600.

By providing us with your phone number(s) or email address, you give your consent for us, our agents, and our collection agents to contact you at these numbers and to leave live or pre-recorded messages regarding any accounts or services. For greater efficiency, calls may be delivered by an auto dialer.

Outpatient PharmacyAs an added convenience for our patients, we dispense medications associated with your care from our outpatient pharmacy. We offer this service to ensure continuity of care. Ask a member of your medical oncology care team for more information.

Support ServicesWe offer many on-site services that compliment your care. These include dietary, social work, clinical trials, genetic counseling, mental health counseling, survivorship, support groups, occupational therapy, image recovery, lymphedema specialists, and chaplain support. You may find websites like caringbridge.org or livestrong.org helpful as well.

Oncology Care ModelNCS has been selected to participate in the Medicare initiative called the Oncology Care Model (OCM). By doing so, we have agreed to a different way of being paid by Medicare. The goal is to provide our patients with even more coordinated high quality cancer care and to lower the overall cost of care.

PLEASE NOTEIn keeping with our intent to provide a safe and healthy environment, smoking is not allowed on any of our campuses; this includes e-cigarettes, vaping and smokeless tobacco. For the consideration of our patients and their families, we do not permit children or pets in the treatment area. Due to potential patient allergies, latex balloons are not allowed. Privacy laws prohibit the use of cameras or video during your visit. We comply with applicable federal civil rights laws and don’t discriminate on the basis of race, color, national origin, age, disability, or sex. Language assistance services (free of charge) are available to you. Please request this service when scheduling your appointment.

17201 Wright Street Suite 200 Omaha, NE 68130Phone (402) 334-4773 Fax (402) 330-7463

NebraskaCancer.com

Welcome to Nebraska Cancer Specialists!

HELLO! PAGE 3

We offer many

on-site services

that compliment

your care such as

nutrition, genetic

counseling and

occupational

therapy.

Name: ___________________________________

Date of Birth: _____________________________

Today’s Date: _____________________________

Reason for Today’s Visit: ___________________

_________________________________________

_________________________________________

PREVIOUS CANCER DIAGNOSES

Types of Cancer: __________________________

_________________________________________

Treatment Received and Where: _____________

_________________________________________

PERSONAL MEDICAL HISTORY

Allergies/Type of reaction (ex. rash, itching):

_________________________________________

_________________________________________

_________________________________________

Illnesses/Medical History: __________________

_________________________________________

_________________________________________

Past Surgeries: ___________________________

_________________________________________

_________________________________________

_________________________________________

Do you have a Power of Attorney? YES NO

Do you have a Living Will? YES NO

Do you have a DNR order? YES NO

SOCIAL HISTORY

Currently Live With: _______________________

Alcohol (quantity per week): _________________

Tobacco Use (circle): CURRENT NEVER PAST

CIGARETTES CIGARS E-CIGARETTES

CHEWING

Amount smoked per day: ___________________

Year started __________ Year quit __________

Illegal Drug Use (circle): YES NO

Marijuana Use (circle): YES NO

WORK HISTORY

Occupation(s): ____________________________

_________________________________________

Military Service (past or present): ____________

_________________________________________

Any exposure to toxins, fumes, radiation, or

chemicals? (circle): YES NO

If yes, what types?__________________________

_________________________________________

FAMILY MEDICAL HISTORY

Please include parents, grandparents, siblings,

aunts, and uncles.

Relative Illness Age at Diagnosis Alive/Deceased

_________________________________________

_________________________________________

_________________________________________

_________________________________________

Patient History and

Review of Systems

NAME: _____________________________________________ DATE OF BIRTH: _____________________

REVIEW OF SYSTEMS

CONSTITUTIONAL YES NO Weight loss in past year ___ ___ Fever in last month ___ ___ Night sweats ___ ___ Fatigue ___ ___ Appetite change ___ ___ EYES, EARS, NOSE, THROAT YES NO Blurred or double vision ___ ___ Nose bleeds ___ ___ Hearing loss ___ ___ Mouth sores ___ ___ Sore throats ___ ___ Hoarseness ___ ___ Trouble swallowing ___ ___ Sinus problems ___ ___ RESPIRATORY YES NO Shortness of breath ___ ___ Cough ___ ___ Coughing up blood ___ ___ Bronchitis ___ ___ Pneumonia ___ ___ Emphysema or COPD ___ ___ Asthma ___ ___ Blood clots to lung ___ ___ Flu Shot ___ ___ Date last received: _________ Pneumonia Shot ___ ___ Date received: __________ CARDIOVASCULAR YES NO Chest pain ___ ___ Palpitations ___ ___ Swelling in feet or legs ___ ___ High blood pressure ___ ___ Heart valve disease ___ ___ Heart murmurs ___ ___ Coronary artery disease ___ ___ High cholesterol ___ ___ Previous heart attack ___ ___ Congestive heart failure ___ ___ Irregular heart beat ___ ___ Blood clots to leg/arm ___ ___ SKIN YES NO Rash ___ ___ Itchiness ___ ___ GASTROINTESTINAL YES NO

Nausea/ vomiting ___ ___ Abdominal pain ___ ___ Liver disease/hepatitis ___ ___ Peptic ulcers ___ ___ Diarrhea ___ ___ Rectal bleeding ___ ___ Constipation ___ ___ Colonoscopy ___ ___ Date last performed: ________ Sigmoidoscopy ___ ___ Date last performed: ________ Other Scope ___ ___ Date last performed: ________ HEMATOLOGIC YES NO Anemia ___ ___ Low platelet counts ___ ___ Enlarged lymph glands ___ ___ Abnormal bleeding ___ ___ Familial thalassemia ___ ___ Excessive bruising ___ ___ ENDOCRINE YES NO Diabetes ___ ___ Thyroid disease ___ ___ NEUROLOGICAL YES NO Headaches ___ ___ Dizziness ___ ___ Fainting ___ ___ Seizures ___ ___ Difficulty walking ___ ___ Numbness feet/hands ___ ___ Stroke ___ ___ PSYCHOSOCIAL YES NO Depression ___ ___ Anxiety ___ ___ Insomnia ___ ___ Mental illness ___ ___ Drug abuse ___ ___ Alcohol abuse ___ ___ MUSCULOSKELETAL YES NO Arthritis ___ ___ Osteoporosis ___ ___ Joint pain ___ ___ New bone pain ___ ___ Fractures (in past 2 yrs) ___ ___

GENITOURINARY YES NO Pain with urination ___ ___ Blood seen in urine ___ ___ Bladder infections ___ ___ Kidney infections/stones ___ ___ Kidney disease ___ ___ **MALES ONLY** YES NO Incontinence ___ ___ Slow Stream ___ ___ Dribbling ___ ___ Erectile Dysfunction ___ ___ Prostate/Rectal Exam ___ ___ Date last performed: ________ PSA drawn ___ ___ 1st result: _______________ Most recent result:__________

**FEMALES ONLY** GYNECOLOGICAL YES NO Fibrocystic ovaries ___ ___ Fibrocystic breasts ___ ___ Date of last mammogram:_______ Any breast biopsies in past ___ __ Date of last pap/pelvic exam:____ Currently Pregnant ___ ___ Desire for fertility ___ ___ # of pregnancies__# of children __ # spontaneous abortion/miscarriage ___________ # of therapeutic abortions _______ Breast Feed ___ ___ Age at first live birth: ___________ Age menstrual periods began ____ Date of last menstrual period __ Menstrual cycle length ___ days Menopause Status: Pre Peri Post Age when menopause began __ Taking hormonal therapy___ ___ How long _____ Type ______ Taking birth control past or present ____________________________ How long _____ Type ______ Number of Living Children ______

Anything else you would like your doctor to know, please describe below: ______________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Area Support Groups

Familial Cancer Risk Assessment Form

Today’s Date: _____________________________

Patient Name: _____________________________________ Date of Birth: __________________________________

Your answers to the following questions will help us evaluate you and your family’s cancer risk. We are

interested in any cancer in a blood relative (for example; breast, colon, lung, uterine, pancreatic, prostate, ovarian, skin

cancer, leukemia or lymphoma). A maternal relative is on your mother’s side of the family. A paternal relative is on your

father’s side of the family. If information is unknown, just leave blank.

Have you or any of the following blood relatives ever had cancer?

Relative Living? Type(s) of cancer Age when

cancer(s) found Yourself ______________________ ________ Mother Yes No ______________________ ________ Maternal grandmother Yes No ______________________ ________ Maternal grandfather Yes No ______________________ ________ Father Yes No ______________________ ________ Paternal grandmother Yes No ______________________ ________ Paternal grandfather Yes No ______________________ ________

How many blood-related sisters do you have? ___________

How many of them have ever had cancer? ______________

For each blood-related sister who had cancer, list the type(s), and her age when the cancer was found. For a half-sister,

write M for maternal or P for paternal.

Sister Half? Living? Type(s) of cancer Age when

cancer(s) found 1 _____ Yes No __________________________ ________ 2 _____ Yes No __________________________ ________ 3 _____ Yes No __________________________ ________

How many blood-related brothers do you have? __________

How many of them have ever had cancer? ______________

For each blood-related brother who had cancer, list the type(s), and his age when the cancer was found. For a half-

brother, write M for maternal or P for paternal.

Brother Half? Living? Type(s) of cancer Age when

cancer(s) found 1 _____ Yes No __________________________ ________ 2 _____ Yes No __________________________ ________ 3 _____ Yes No __________________________ ________

Continue on next page

Area Support Groups

Familial Cancer Risk Assessment Form

Patient Name: _______________________________________

How many blood-related children do you have? ____________

How many of them have ever had cancer? ________________

For each of your blood-related children who had cancer, list the type(s), and how old he or she was when the cancer was

found.

Child Living? Type(s) of cancer Age when

cancer(s) found 1 Yes No _____________________________________ ________ 2 Yes No _____________________________________ ________ 3 Yes No _____________________________________ ________

Do you have any other blood relatives who have had cancer? Yes No

For each of your other blood relatives who have had cancer, list how he or she is related to you (your maternal aunt,

paternal uncle, maternal first cousin, etc.), the type(s) of cancer, and how old he or she was when the cancer was found.

Relation Living? Type(s) of cancer Age when

cancer(s) found ____________ Yes No ___________________________________ ________ ____________ Yes No ___________________________________ ________ ____________ Yes No ___________________________________ ________ ____________ Yes No ___________________________________ ________ ____________ Yes No ___________________________________ ________ ____________ Yes No ___________________________________ ________

Have any of your relatives had polyps in the colon or rectum? Yes No

If yes, which relative(s)? _____________________________________________________________________________

To what country do you trace your ancestors (for example, France, Germany, China, African American, Mexico)?

Your Mother’s Father _______________________________ Your Mother’s Mother _____________________________

Your Father’s Father _______________________________ Your Father’s Mother _____________________________

Is your family of Jewish descent? Yes No Don’t know

Have you ever had any genetic testing? Yes No Don’t know

If yes, when? _________________________________ Results? _____________________________________________

Has any family member ever had genetic testing? Yes No Don’t know

If yes, when? _________________________________ Results? _____________________________________________

Do you have any additional concerns you would like to discuss with the genetics counselor? _______________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

Your physician and genetic counselor will review this form and call to offer you a genetic consultation, if indicated.

Best number to call: __________________________________ Best time to call: ________________________________

Ok to leave message? Yes No

Medication List

Patient Name Date of Birth

Preferred Pharmacy

Medications (include vitamins, herbals, and over-the-counter)

Prescriber (Dr.'s name who prescribes medication)

Dose How often?

Pharmacy Location

Providers Seen in the last 5 Years

Provider Name Current Patient Yes or No

Reason for Seeing Location

Medical Insurance

Information Form

Name ____________________________________________ Date of Birth ____________________

Please present your insurance card and a driver’s license or picture ID to the Patient Scheduler. Prior authorization may be required before you see one of our providers.

Assignment of Benefits I hereby authorize Nebraska Cancer Specialists, the Physicians of Oncology Hematology West PC, to furnish my insurance company(s) or designated attorney, all information which they may require in order to issue payment. I herby assign all payment(s) for services rendered by NCS to be issued directly to Nebraska Cancer Specialists. This assignment applies to all dates of service until revoked. I have requested medical services from Nebraska Cancer Specialists and understand by making this request I become fully responsible for any and all charges incurred in the course of the treatment. _____________________________________________________ _______________________ Patient/Responsibility Party Signature Date __________________________________________________________________________________ Name of person who carries primary insurance Date of Birth Relationship to Patient _____________________________________________________ _______________________ Witness Date Medicare Recipients Only:

1. Is Medicare your primary insurance? ☐ Yes ☐ No

2. Are you receiving ‘Black Lung’ benefits? ☐ Yes ☐ No

3. Are services to be paid by a government research program? ☐ Yes ☐ No

4. Has the Department of Veterans Affairs authorized and agreed

to pay for your care at NCS? ☐ Yes ☐ No

5. Was this medical condition due to an accident? ☐ Yes ☐ No

If yes, please explain if it was: work related, auto, injured at home, or other:

6. Are you or your spouse covered under an employer’s health plan

through your/their employment or that of a family member? ☐ Yes ☐ No

Consent to Treat, Notice of Privacy Practices

Patients’ Rights & Responsibilities

I give permission for Nebraska Cancer Specialists (NCS) to render to me medical treatment. I also understand I have the right to refuse any procedure or treatment and to discuss all medical treatments with my provider. My signature below acknowledges that I have been offered the Notice of Privacy Practices and Patient Rights and Responsibilities (a copy is available at the office upon request). ______________________________________________________________________ Signature of patient or legal guardian Date ______________________________________________________________________ Printed name of patient Printed name of legal guardian ______________________________________________________________________ Witness Date

Area Support Groups Request for No Information

Disclosure

Nebraska Cancer Specialists is committed to protecting our patient’s privacy. Without authorization, messages left on answering machine, voicemail, or with other individuals will be limited to the caller’s name that they are calling for Nebraska Cancer Specialists, and the phone number to call. If you prefer that more complete information be provided, please fill out the form below.

Please provide the following contact information:

Cell

Work

Home

Other

Check which applies:

OK to leave message

Do not leave message

The following individuals CAN be given information:

Name: ______________________ Relationship: ___________ Phone Number: ___________

Name: ______________________ Relationship: ___________ Phone Number: ___________

Name: ______________________ Relationship: ___________ Phone Number: ___________

The following individuals CANNOT be given information:

Name: ___________________________________________

Name: ___________________________________________

____________________________________________________________________________ Printed Name Date

____________________________________________________________________________ Signature Relationship

This letter is only meant as a notification.

No action is required on your part.

Oncology Care Model Beneficiary Notification Letter Nebraska Cancer Specialists is participating in a Medicare initiative called the Oncology Care Model.

You are receiving this letter because your health care provider has identified you as a patient who may

receive care through this initiative. Oncology practices participating in the Oncology Care Model,

including Nebraska Cancer Specialists, will work with Medicare to improve cancer care for patients

receiving chemotherapy.

Your Medicare rights have not been changed. You still have all the same Medicare rights and protections, including the right to choose which health

care provider you see. However, because Nebraska Cancer Specialists chose to participate in the

Oncology Care Model, all of Nebraska Cancer Specialists’ Medicare beneficiaries who meet the

eligibility criteria of this initiative will receive care under the initiative, including access to patient-

focused services (listed below). If you do not wish to receive care under the Oncology Care Model, you

must choose a health care provider who does not participate in this initiative to receive care. Regardless

of which health care provider you see, Medicare will continue to cover all of your medically necessary

services.

The Oncology Care Model aims to improve cancer care. The Oncology Care Model was designed to help ensure that you receive the right care at the right time

by giving your health care provider extra resources to manage your cancer care. Your health care

provider will use these resources to give you access to the patient-focused services listed below.

Medicare will monitor Nebraska Cancer Specialists to make sure you and other people with Medicare

receive quality care. Nebraska Cancer Specialists will regularly receive information from Medicare

about its participation in the initiative.

You will receive access to patient-focused services. As part of the Oncology Care Model, Nebraska Cancer Specialists will give you access to patient-

focused services aimed at meeting your individual needs while you are receiving chemotherapy or

hormonal therapy. Under the initiative, you can:

•Contact a health care provider who has access to your medical records 24 hours a day, 7 days a week

• Work with your health care provider to create a detailed care plan that meets your needs

• Work with your health care provider to access other patient-focused supportive services

Talk to your health care provider to learn more about these patient-focused services.

These patient-focused services are called Enhanced Services, and Medicare pays for these services via

the Monthly Enhanced Oncology Services (MEOS) payment (G9678). Claims for the MEOS payment

This letter is only meant as a notification.

No action is required on your part.

will appear on your Medicare Summary Notice (MSN) (Medicare billing statement) as “Oncology Care

Model {OCM) Monthly Enhanced Oncology Services {MEOS) payment for enhanced care manage

{G9678).” Note that the date of service on the MSN may be different from the date on which you

actually received services and a health care provider in the practice—other than the health care

provider you actually saw—may bill for that service. As shown under the “Maximum You May Be

Billed” section of the MSN for the MEOS claim, you will not be responsible for paying for any portion

of these patient-focused services; Medicare will cover the full amount of these services.

Your feedback is important. Medicare may also ask you to answer a survey about the services and care you received from Nebraska

Cancer Specialists. The survey will be mailed to you. Your feedback will help improve care for all

people with Medicare who receive chemotherapy or hormonal therapy.

Find more information. For more information about the Oncology Care Model, you can:

• Visit www.innovation.cms.gov/initiatives/oncology-care/

• Call Nebraska Cancer Specialists at 402-334-4773

• Call 1-800-MEDICARE (1-800-663-4227). TTY users can call 1-877-486-2048

If you have concerns or complaints about your care, talk to your health care provider, or contact your

Beneficiary and Family Centered Quality Improvement Organization (BFCC-QIO). To get your

BFCC-QIO’s phone number, visit Medicare.gov/contacts or call 1-800-MEDICARE.

To find a different health care provider, visit www.Medicare.gov/physiciancompare, or call 1-800-

MEDICARE.

Organize your care get the support you need.Join Navigating Care today!

www.navigatingcare.com

USE NAVIGATING CARE TO:

» Access your health information 24/7

» Receive personalized patient education

» Be prepared for your doctor visits

» Complete forms from home

» Review lab and test results

» Communicate with secure messaging

» Connect with other survivors like you

Can I receive an estimation of cost for my MRI?

QUICK START INSTRUCTIONS

1. Give your full name and email address to asta� member.

2. Watch your email for an invitation from yourclinic with the subject “Join our PatientPortal.”

3. Click on the activation link in your invitation.

Tips for Using Navigating Care: » If you do not receive an email invitation, check both the Spam and Junk folders in your email inbox.

»

» Create a bookmark on your browser: https://www.navigatingcare.com/account/login .

» For additional help, call 1-800-925-4456 or email support@navigatingcare.com.

Sign Up Today:

Watch for an email invitation to get started! .

Phone (402) 334-4773 • Fax (402) 330-7463

Keep your login and password in a secure place where you can find it for future reference, if needed.

NebraskaCancer.com

Introduction to Navigating Care

Find support and connect with others

Manage settings or preferences

Track your care team, support and more

Track appointments and events

Communicate via secure message with your care team

For additional help, call 1-800-925-4456 or email support@navigatingcare.com.

Read diagnosis and medication info

Access visit notes, labs, vitals and more

View clinic details and recent updates

Track adherence and symptoms

Additional Information

The red circle indicates that something new has been added to that tab.

to your diagnosis and treatment. Gain a better understanding of your diagnosis in the comfort of your home. Learn about medications, what side

To identify the new information look for titles in a bolder font.

At the bottom of the “Health Records” tab you can track information and concerns, even if it’s not part of your medical record.

The “Education” tab contains information specific

e�ects to anticipate and how to manage them.

Find support and connect with others

Manage settings or preferences

Track your care team, support and more

Track appointments and events

Communicate with our office via secure message

Read diagnosis and medication info

Access labs, vitals and more

View clinic details and recent updates

Track how you’re feeling

Introduction to Navigating Care

Find support and connect with others

Manage settings or preferences

Track your care team, support and more

Track appointments and events

Communicate via secure message with your care team

For additional help, call 1-800-925-4456 or email support@navigatingcare.com.

Read diagnosis and medication info

Access visit notes, labs, vitals and more

View clinic details and recent updates

Track adherence and symptoms

Additional Information

The red circle indicates that something new has been added to that tab.

to your diagnosis and treatment. Gain a better understanding of your diagnosis in the comfort of your home. Learn about medications, what side

To identify the new information look for titles in a bolder font.

At the bottom of the “Health Records” tab you can track information and concerns, even if it’s not part of your medical record.

The “Education” tab contains information specific

e�ects to anticipate and how to manage them.

Experience you can trust.Compassion you can feel.

WELCOME TONebraska Cancer Specialists

Thank you for choosing Nebraska Cancer Specialists

for your care. We are proud to provide patients, families

and caregivers with personalized, comprehensive health

care and continued support.

Our years of experience have enabled us to develop

Nebraska’s leading community oncology practice. We

have taken personal measures to make sure your time

with us is just right. YOU are our top priority. Take

a deep breath and allow us to provide you with the

dedicated and compassionate care you deserve.

The Physicians and Staff of Nebraska Cancer Specialists

5 Convenient Locations

Dedicated Physician Teams

Oncology Patient Financial Advocates

100+ Active Clinical Trials

WELCOME TONebraska Cancer Specialists

WHAT ISCommunity Oncology?

TreatmentChemotherapy

Immunotherapy

Targeted Therapy

Integrative ServicesOccupational Therapy

Mental Health

Genetic Counseling

Pharmacy

Research100+ Active Clinical Trials

Early Stage Research

Proudly the 1st to enroll patients globally in several trials

Supportive Care ClinicsGeriatric

Survivorship

Palliative

5 Convenient Locations

Dedicated Physician Teams

Oncology Patient Financial Advocates

100+ Active Clinical Trials

Nebraska Cancer Specialists is a subspecialty

practice of collaborating physicians who are

devoted to oncology (tumors and cancer) and

hematology (diseases of the blood and blood-

forming organs). The physicians of Nebraska

Cancer Specialists are some of the most experienced

and highly qualified in the area. At NCS, not only will you

have a medical oncologist, you will have an entire dedicated

team to support you throughout your care.

You are not alone; we are here to walk with you every step of the way.

EXPERIENCEYou Can Trust

“You do not treat us as patients, but as friends. You

have been caregivers, teachers, confidants, sounding

boards, cheerleaders, and confessors. We truly

appreciate each and every one of you.”

Roger Timperly

Awarded to outpatient oncology practices for excellence in cancer care.

Complete this checklist

1. Fill out your paperwork

Review all papers in this packet

Fill out all forms

Bring a list of your allergies and medications

2. Bring what you need with you

Insurance card

Insurance copay

Valid photo identification

3. Prepare for your conversation with your doctor

Call us if you would like interpretation in yourpreferred language

Read this guide about services available to you andyour family

Write down and bring your list of questions to yourfirst visit

4. Arrange for a friend or family member to join you

5. Make a plan to be on time for your appointment

Date & Time:

Location:

FIRST APPOINTMENTChecklist

Awarded to outpatient oncology-hematology practices for excellence in cancer care.

4

WHAT TO ASKYour Care Team...

What kind of cancer do I have?

What stage is my cancer?

What are the risks and side effects of my treatment?

What are the goals of my treatment?

How long does each treatment last?

Will radiation be a part of my treatment?

When should I call about side effects?

How will I know if treatment is working?

How will treatment effect my daily life?

How can I stay as healthy as possible during treatment?

Thank you doesn’t seem to be enough to express how grateful

I am for all the staff has done for me. You have made me feel

comfortable and so well taken care of. ”Teresa Kardell

I am impressed with the quality

of character of the doctors and

staff. They are noticeably a cut

above people I have met in other

professions.”

William Craven

WHAT TO ASKYour Care Team...

What kind of cancer do I have?

What stage is my cancer?

What are the risks and side effects of my treatment?

What are the goals of my treatment?

How long does each treatment last?

Will radiation be a part of my treatment?

When should I call about side effects?

How will I know if treatment is working?

How will treatment effect my daily life?

How can I stay as healthy as possible during treatment?

Notes

Midwest Cancer Center - Legacy17201 Wright Street, Suite 200, Omaha, NE 68130

Estabrook Cancer Center - Methodist8303 Dodge Street, Suite 250, Omaha, NE 68114

Henry Lynch Cancer Center - Bergan7500 Mercy Road, Suite 1300, Omaha, NE 68124

Midwest Cancer Center - Papillion611 Fenwick Drive, Papillion, NE 68046

Health Park Plaza - Fremont450 East 23rd Street, Fremont, NE 68025

Phone (402) 334-4773 • Fax (402) 330-7463

NebraskaCancer.com