Get Kaiser Pharmacy Release - Caseycorporation.com

Filling out the Kaiser Pharmacy Release form is essential for users to authorize the use and disclosure of their pharmacy information. This guide will walk you through the process in a clear and supportive manner, ensuring you understand how to complete each section effectively.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the Authorization for Use and Disclosure of Pharmacy Information form.
2. Begin by providing your personal information. Enter your name, medical record number, address, date of birth, city, state, zip code, email, and telephone number.
3. Specify your membership region by checking either Northern California or Southern California.
4. Indicate who the pharmacy information should be disclosed to by providing the recipient's name and address details.
5. Select the specific pharmacy information you want to be used or disclosed by marking all applicable options, along with the relevant date ranges for each.
6. If you are requesting alcohol or drug treatment records, ensure to check the corresponding box and provide the necessary dates.
7. Choose your preferred media type for receiving the information by selecting either electronic or paper.
8. Select your delivery preference for the records: email or mail, providing the necessary email address if choosing electronic delivery.
9. State the purpose for which the pharmacy records and information will be used.
10. Sign and date the authorization form. If you are not the patient, indicate your relationship to the patient.
11. If applicable, provide verification of the signee's identity in the designated internal use section.
12. Once all fields are filled out, review your information for accuracy. You can then save changes, download, print, or share the completed form.

Complete your pharmacy release authorization online today to ensure smooth processing of your records.