Get Ca Kaiser Ns-9934 2016

Filling out the CA Kaiser NS-9934 online can seem daunting, but with clear guidance, the process can be manageable. This guide will provide step-by-step instructions to help you complete the form with confidence and ease.

Follow the steps to fill out the CA Kaiser NS-9934 online

1. Click the ‘Get Form’ button to access and open the CA Kaiser NS-9934 form in your editor of choice.
2. Begin by entering the patient name in the designated field at the top of the form.
3. Next, fill in the medical record number, birth date, address, city, state, and zip code.
4. Provide a phone number and email address in the respective fields to ensure you can be contacted regarding your request.
5. Identify the recipient for the information by checking the box if the same as the patient; if not, provide the recipient’s name and contact details including address, phone number, and email.
6. Specify the purpose of the disclosure by checking one of the provided options, such as personal use or medical treatment.
7. Select one of the three options to identify the health information to be released: option one for form completion, option two for the last two years of records, or option three for specific records where you will need to enter date(s) and types of records.
8. If you selected option three, proceed to step one to enter the date range or specific dates of the records required.
9. Then, in step two, indicate the types of records to be released by checking the relevant boxes.
10. Decide whether to include mental health treatment records, addiction medicine treatment records, or HIV test results by checking the appropriate boxes.
11. Select the preferred media type for the information, choosing either electronic or paper.
12. Choose how you would like to receive the information by selecting electronic delivery, mail, or pickup.
13. Acknowledge the duration of authorization by understanding it remains effective for one year, or six months in Washington, D.C.
14. Finally, sign and date the authorization to complete the process. If you are completing this on behalf of someone else, ensure to print your name and relation in the designated area.

Complete your CA Kaiser NS-9934 form online today for a seamless experience.