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Get Kaiser Permanente 0002-1966 2010-2024

Uthorize: To disclose to: Kaiser Permanente HIMS Release of Information Dept. 4000 Dekalb Technology Parkway, Bldg 200 Suite 200 Atlanta, GA 30340 Phone: (770) 220-3870 Fax: (770) 220-3705 Name of Member/Patient (List other names used) Date of Birth (MM/DD/YYYY) Medical Record Number / Group # Daytime Phone Number City S t ate Street Address City Ci State Zip Distribution: Records and information pertaining to: Street Address Recipient Name Mail to Address Above Fax Number.

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