Forms & Payment

Accepts new patients

Medicare Medicaid Workers' compensation Other
Yes Yes Yes Yes

Medical insurance plans and payment options

Coventry, Blue Cross/ Blue Shield, Medicare

Cash, American Express,Visa, Mastercard, Discover

(For financial assistnce we suggest you investigate Care Credit (see link to carecredit.com on side bar), a service of GE Financial that is really user friendly and hassle free)

Office information from Dolf R Ichtertz, MD

CMC Arthroplasty Outcome Questionnaire

CTS Questionnaire

Hand Diagram
Use the hand diagram to indicate the location of sensations. Mark the areas on the drawing with the symbol that best describes the sensation that you feel.

New Patient Letter

Patient Information page 1

Patient Information page 2

Pre-Operative Clearance Form

Shoulder Outcome Questionnaire

Spanish Shoulder Outcome Questionnaire

TarsalTunnelOutcomeQuestionnaire

Tennis Elbow Outcome Questionnaire

Vocational Symptom Relationship Checklist

www.nhsi@carpaltunnelrelief.net

Nebraska Hand & Shoulder Institute, P.C. 716 Alpha St, Grand Island, NE USA 68803 View map Phone (800) 433-9147 Fax (308) 389-3390

Carol, Lisa and Chris work hard to ensure that your records are prepared promptly and accurately

No orthopaedic surgeon practices without the support of a professional team and I am certainly no exception!
I am pleased to introduce you to my highly trained and eager treatment team that makes everything possible. Lisa works the front desk, will collect your office visit payment and schedule your appointment. Carol N. will assist you with billing concerns. Dena, our nurse, assists with wound and cast care. She also coordinates consultations with other physicians and schedules surgery. Dena also first assists in surgery. Katie, our electrodiagnostic technician performs comprehensive nerve tests and quantitative senory exams under my direct supervision. Together, we are committed to providing the best possible orthopaedic care to our rapidly growing patient family.

This website is provided by the American Academy of Orthopaedic Surgeons as a service to its members. All materials on this Web site have been created, developed or assembled by the member physician, who is solely responsible for its content and any permissions necessary to properly place the materials on this website. The AAOS does not review this information nor does it exercise editorial control over it and consequently AAOS is not liable for any damage that may be caused by this information.