Get Kaiser Permanente Forms

Filling out the Kaiser Permanente Forms correctly is vital for ensuring that necessary services, such as the Newborn RSV Protection Program, are provided. This guide offers a clear and supportive approach to completing the forms online, ensuring you understand each component and section.

Follow the steps to successfully complete the form

1. Click ‘Get Form’ button to obtain the form and open it in your chosen online editor.
2. Fill in the date of birth and gestational age at birth. Pay close attention to the gestational age, as this section is crucial for treatment eligibility.
3. Provide the parent's name along with their home and work phone numbers. If applicable, ensure that the contact details are up-to-date for effective communication.
4. List the referring physician’s name in print format along with their office address, and telephone and fax numbers. These details facilitate the referral process.
5. In the diagnosis section, check all applicable criteria from the AAP treatment guidelines. It is essential to review each option carefully to determine eligibility.
6. Attach any necessary documentation, such as the Newborn Hospital Discharge Summary and/or a specialist consultation, as required.

Complete the Kaiser Permanente forms online to ensure timely processing of your requests.