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  • Authorization For Kaiser Permanente To Use/disclose Protected ... - Info Kaiserpermanente

Get Authorization For Kaiser Permanente To Use/disclose Protected ... - Info Kaiserpermanente

1. Member must complete this section PATIENT NICKNAME / MAIDEN NAME / OTHER HEALTH RECORD NO. Kaiser Foundation Health Plan of the Northwest Kaiser Foundation Hospitals Authorization for Kaiser Permanente.

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Or, call Member Services at 1-888-901-4636. A digital version of your member ID card is available on the Health Coverage card on the secure home page. On the mobile app, you'll find your digital ID card on the home tab. Your member ID number is displayed on the left side above your name.

Ask them to send your records to Kaiser Permanente Medical Records, 10220 SE Sunnyside Road, Clackamas, OR 97015 or fax to 877-849-4116 or via email to nw-med-rec@kp.org.

Most insurance cards in the U.S. contain the same basic information, including: The name of your insurance company and contact information such as a customer service phone number, email address and website. ... Your insurance I.D. number (or policy number) on the insurance card indicates the coverage your plan provides.

To request these records, fill out and initial all areas of the authorization for Kaiser Permanente to use/disclose protected health information (PHI) form (PDF) and a cost letter, if required. You can return this information by mail, fax, or in person at the the nearest Release of Information office.

Choose "Browse," locate your file through the attachment box, select the file's name, and then select "Attach." To add multiple files from within the same folder, hold down the "Ctrl" key while selecting the files, then select "Attach." Repeat for any other files you wish to attach. Choose "Send."

Kaiser Foundation Health Plan, Inc. will cover a second opinion consultation from a non-Permanente Medical Group physician only if the care has been preauthorized by a Permanente Medical Group.

A: Contact your prior physician(s) to understand their process for sharing medical records. Ask them to send your records to Kaiser Permanente Medical Records, 10220 SE Sunnyside Road, Clackamas, OR 97015 or fax to 877-849-4116 or via email to nw-med-rec@kp.org.

Your policy number on your health insurance card will not be the same as your group number. The policy number on health insurance refers to your individual member number, but the group number is different. Normally, your group number refers to your employer or where you get your insurance coverage from.

The policy number is just like a unique account number. It is given to the insured person by the insurer for identification of their account. The number is 8 to 10 digit long and is generally written on the insurance card or statements that are issued by the company.

200, Ste. 200, Atlanta, GA 30340. It may take up to 10 business days to process your request. To check the status of your request, contact Medical Records Administration at (770) 220-3870.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232