Neb. Rev. Stat. § 83-384: Residential facilities; application for admission; contents.

An application for admission to a residential facility shall contain the name, age, and place of residence of the person for whom admission is requested. The application shall set forth the name of the person submitting the application and the capacity in which he or she makes the application. The application shall contain authorization for the department to obtain all relevant medical records and information concerning the person for whom admission is requested.