Nebraska Residents

Note: Please print this page so you have the instructions available while filling out the forms.

OIG/HHS Medicare/ Medicaid Excluded list:

The form you need to complete for the Medicare/Medicaid excluded list is found on the Federal Government web site http://exclusions.oig.hhs.gov

Directions to complete the form

• On the web page referred to above, type your name(s) in the spaces provided.
• Include any names used in the past seven years
• Click the Search button and print the results
• Turn in the printed results to your program chair

Criminal Record Check:

The form you need to complete to request the background check is found on the Nebraska State web site at http://www.nsp.state.ne.us/FindFile.asp?ID=209

Turn in the original search result in to your program chair.

Abuse Registry Check:

The form you need to complete to request the Dependent Adult/Child abuse check can be downloaded below.  Instructions for filling out the form can be found at: http://www.dhhs.ne.gov/nea/cr/AgReqBackChckFrm.pdf   Fill out the form and bring it in to the director of nursing 6 weeks before the start of the first semester of classes.  Incomplete or missing forms will jeopardize your ability to start classes.