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Mail Pick-up AUTHORIZATION TO RELEASE/OBTAIN PROTECTED HEALTH INFORMATION 1. I AUTHORIZE: 2. TO RELEASE TO: Name of sending person/organization Name of receiving person/organization Street Address.

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Kaiser Permanente HMO (California) - Group #7145 (Northern CA), Group #230178 (Southern CA)

We issue a health plan identification card to all members. This card lists the member's name, ID number, and health plan network and/or product name. Ask to see the member's ID card at each visit.

Fax: Medical Records: 916-734-2126.

Your health record number (also referred to as your member ID number) will be printed on your Kaiser Permanente ID card, which you will receive in the mail. Use your health record number to access your medical record, refill prescriptions, and more.

Medical, Vision and Dental Medical PlanGroup NumberTelephone NumberKaiser Permanente HMO7029(800) 813-2000 (503) 813-2000Moda Health10002802(877) 605-3229PEBB Statewide Plan108601(800) 423-9470Providence Choice PPO106528(800) 423-9470

Need help? Contact your agent for personalized help. You may also call Kaiser Permanente Customer Support at 1-800-423-3473 or call Covered California at (800) 300-1506.

Upon discharge, typically a nurse presents and explains written instructions to the patient or patient surrogate. Discharge instructions provide critical information for patients to manage their own care.

You can view them online or request electronic copies if you get care at a Kaiser Permanente medical office. You can also request your health information be sent to any person or entity. If you get care from a non-Kaiser Permanente provider, contact them to get copies of your record, or to have your record transferred.

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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