Form NSBC2:08 (8) "Description of Mental Health or Substance Abuse Condition or Impairment" - Nebraska

What Is Form NSBC2:08 (8)?

This is a legal form that was released by the Nebraska Judicial Branch - a government authority operating within Nebraska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 3, 2013;
  • The latest edition provided by the Nebraska Judicial Branch;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form NSBC2:08 (8) by clicking the link below or browse more documents and templates provided by the Nebraska Judicial Branch.

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Download Form NSBC2:08 (8) "Description of Mental Health or Substance Abuse Condition or Impairment" - Nebraska

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To be used with Questions 25 and 26
FORM 8 / DESCRIPTION OF MENTAL HEALTH OR
SUBSTANCE ABUSE CONDITION OR IMPAIRMENT
Name
First
Middle
Last
Suffix
Dates of treatment:
From Mo/Yr
To Mo/Yr
Name and complete address of attending physician or counselor:
Name of physician or counselor
Physician's or Counselor's current address
City
State __________________Zip
Country
Province
Telephone (
)
Name and complete address of hospital or institution:
Name of hospital or institution
Hospital's or Institution's current address
City
State ________________Zip
Country
Province
Telephone (
)
Describe the condition or problem
Describe any treatment and/or monitoring program
The Nebraska State Bar Commission is aware of HIPAA requirements.
EA - Nebraska
Revised 09/03/2013
NSBC 2:08
To be used with Questions 25 and 26
FORM 8 / DESCRIPTION OF MENTAL HEALTH OR
SUBSTANCE ABUSE CONDITION OR IMPAIRMENT
Name
First
Middle
Last
Suffix
Dates of treatment:
From Mo/Yr
To Mo/Yr
Name and complete address of attending physician or counselor:
Name of physician or counselor
Physician's or Counselor's current address
City
State __________________Zip
Country
Province
Telephone (
)
Name and complete address of hospital or institution:
Name of hospital or institution
Hospital's or Institution's current address
City
State ________________Zip
Country
Province
Telephone (
)
Describe the condition or problem
Describe any treatment and/or monitoring program
The Nebraska State Bar Commission is aware of HIPAA requirements.
EA - Nebraska
Revised 09/03/2013
NSBC 2:08