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  • Kaiser Permanente Confidential Communication Request Form

Get Kaiser Permanente Confidential Communication Request Form

CONFIDENTIAL COMMUNICATION REQUEST FORMThis form is to make a request to receive communications of health plan information from Kaiser Foundation Health Plan, Inc. by alternative means or at alternative.

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Individuals have the right to request, and in some cases require, that communications from the covered entity to them be made to an alternative address or by an alternative means than the covered entity would otherwise use. (See § 164.522(b) regarding confidential communications.)

Alternative communication Examples may include using an alternate mailing address or phone number; or using an alternate communication vehicle (phone, mail or email) rather than the provider's standard method of communication.

Patient confidentiality refers to the right of patients to keep their records private and represents physicians' and medical professionals' moral and legal obligations in handling patients' sensitive medical and personal information.

This form is used for you to request Confidential Communications of your Protected Health Information. (PHI). Confidential Communication means communicating with you by alternate means or locations. because of a Privacy Related concern.

This form is used for you to request Confidential Communications of your Protected Health Information. (PHI). Confidential Communication means communicating with you by alternate means or locations. because of a Privacy Related concern.

Under Federal law, patients have the right to request to receive communications of protected health information by alternative means or at alternative locations.

To provide a confidential address for receipt of confidential communications, you can complete the confidential communications request form located at the bottom of the KP.org home page or contact the Member Service Call Center at 1-800-464-4000 (TTY 711) for assistance.

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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