Health Services


Family Planning services are important!  They provide health care that is necessary during reproductive years and allow for the spacing of children.

All Services and records are confidential.  No information will be released to anyone without your written permission, except as required by law.

As your medical provider, it is necessary for us to have a phone number or address where we can leave a message and/or send a letter to you regarding your physical exam or lab results.  If you prefer to be called or written to at a special number or address, let us know.

The cost of services depends on the amount of your income and will be discussed with you to prior to services.  If you do not understand or have a question about how the cost is determined, please ask us.




  • WRITE DOWN any questions you have. 
  • WRITE DOWN the first day of your last menstrual period.  If you are having problems, mark the dates you noticed anything unusual, such as itching, pain, spotting, or a discharge that doesn’t seem normal.
  • AVOID DOUCHING FOR AT LEAST 3 DAYS.  Your pap smear and other lab tests will be more accurate.
  • AVOID INTERCOURSE FOR 2 DAYS OR USE CONDOMS.  Your pap smear and other tests will be more accurate.
  • IF YOU ARE USING BIRTH CONTROL PILLS, BRING THEM WITH YOU.  The clinician needs to know exactly what brand of birth control pills you are taking, especially if pills may be causing your problems.
  • IF YOU USE A DIAPHRAGM, INSERT IT (WITHOUT CREAM OR JELLY) BEFORE YOUR CLINIC VISIT.  The clinician can check the fit and make sure you are inserting it properly.


DID YOUR MOTHER USE Diethylstilbestrol (DES), which is a synthetic estrogen popularly given to pregnant women from 1940 – 1975.  Daughters of those pregnancies have an increased risk for cancer of the vagina and cervix, reproductive tract structural differences, pregnancy complications and/or infertility.  Your mother may not recognize the name DES as the drug came under many different names.  Many times women thought they were taking vitamins.  DES was often given to diabetics and women who had a history of bleeding during early pregnancy or miscarriages.  Ask your mother if she took any medications while she was pregnant with you.  If you were exposed to DES, you will be referred to an OB/GYN physician who is trained to examine and evaluate you.

HAVE YOU HAD Rubella (Three Day Measles) OR BEEN VACCINATED AGAINST, Rubella can infect one in seven women of childbearing age in this country.  This lack of immunity endangers the fetus if a woman catches it during pregnancy.  The placenta is not a barrier against the virus.  Infection can result in miscarriage, stillbirth or birth defects.  Because of the possible risk, women of childbearing age should receive the vaccine only if they are not pregnant and understanding that they should not become pregnant for three months after the vaccination.

If you have a problem with your birth control method or just a question or concern, feel free to call us during office hours.  IN THE EVENT OF AN EMERGENCY that cannot wait and during times that the office is closed, please contact your private physician or go to a hospital emergency room.

If it is your first pelvic exam/Pap test:

  • Know that you do not have to go alone. You have the right to bring a nurse, relative, or a friend into the exam room with you.
  • Tell your provider that it is your first time having a pelvic exam/Pap test
  • Ask your provider to tell you what she/he will do in the visit
  • While the provider performs the different tests, ask her to explain what she is doing
  • Ask questions – a question about your body is never inappropriate.

Women’s Annual Exam

Many women use this appointment to discuss birth control options, exposure to and prevention of sexually transmitted infections (STIs), and to ask sexual and general health questions. This visit may include any of the following depending on your age, if you are sexually active or if you have any problems.

Pelvic exams and pap tests may not be needed until age 21.  Discuss with your provider what tests are right for you.

  • General physical exam
  • Clinical breast exam
  • Pelvic exam
  • Pap test
  • Review of you vaccination status
  • STI infection screening

Clinical Breast Exam

During the visit, the provider may check your breasts for signs of cysts or lumps. You should have your breasts checked by your provider each 1 -2 years depending on your age, medical and family history, and at any time you have a breast problem or concern. Monthly breast self-examination is recommended for some women, depending on age and risk factors. Discuss this with your provider.

Pelvic Exam

The pelvic exam takes only a few minutes. It includes a visual exam of your external sex organs for growths or rashes. It also includes an exam to check your internal sex organs: vagina, uterus, ovaries, and fallopian tubes. The pelvic exam can alert the provider to the presence of ovarian cysts (fluid-filled sacs), uterine fibroids (growths), tumors, and other abnormalities.

Pap Test

The pap test uses a speculum to check for cervical cancer, an instrument that holds the vagina open and makes the visual examination possible. The provider will examine your vaginal walls for inflammation, lesions, or unusual discharge. She will check your cervix for signs of infection, damage, growths, discoloration, unusual discharge, and lesions. This procedure is generally painless.  Someone from our clinic will contact you with the results of your pap test within three weeks.


Vaccinations are an important tool for protecting the health of the community. Three Rivers clinics administer over 6,000 shots per year. As a Nebraska Vaccine for Children Provider, Three Rivers District Health Department offers low cost or no cost immunizations for infants, children, and some adults who are uninsured, whose insurance does not cover immunizations, or who are unable to access services. Three Rivers has also made arrangements with the Nebraska Department of Health and Human Services to provide free vaccinations to homeless, high risk, and under served individuals who are in need of immunizations but cannot afford them or do not have access to them. The Three Rivers clinic is open daily, and in many instances, vaccine is administered at schools, places of employment, and churches throughout the three-county area.

Call Care

Call Care is a local hotline that is available Monday thru Friday from 7am to 7pm to answer medical questions and make referrals to applicable community resources. Three Rivers assists 1,200 clients per year through this service. Calls are handled by a staff of professionally trained public health nurses. Call Care is an excellent choice for people who are looking for fast and accurate information to resolve their minor medical needs.

 Every Woman Matters

Every Woman Matters is a program that offers financial assistance for various diagnostic procedures. The program is for women between the ages of 40 and 64 who meet income eligibility guidelines. Three Rivers District Health Department provides case management for Every Woman Matters in 35 Eastern Nebraska counties.

Additional health services offered by Three Rivers District Health Department include:

  • Tuberculosis screening
  • Lead screening
  • Employee drug testing
  • Daycare employee physical exams
  • School nurse consulting services
  • Car seat inspection & installation
  • Community referrals

Additional Information:

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