healthy.kaiserpermanente.org
Open in
urlscan Pro
92.123.0.214
Public Scan
URL:
https://healthy.kaiserpermanente.org/washington/support/medical-requests
Submission: On August 27 via api from US — Scanned from DE
Submission: On August 27 via api from US — Scanned from DE
Form analysis 2 forms found in the DOM
GET
<form class="autocomplete-search__form" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" method="get" onsubmit="return false">
<label aria-hidden="true" class="autocomplete-search__label screenreader-only" for="autocomplete-search-0__input" id="autocomplete-search-0__label">Search</label>
<div class="autocomplete-search__combobox clear-input-field clear-input-field--initialized" id="autocomplete-search-0__combobox">
<div class="container">
<i class="icon-search" aria-hidden="true"></i>
<input type="search" class="autocomplete-search__input clear-input-textbox" maxlength="50" id="autocomplete-search-0__input" aria-labelledby="autocomplete-search-0__label">
</div>
<div class="container container--global">
<div class="autocomplete-search__listbox -hidden"></div>
<button class="clear-input-button" aria-label="Clear Search" type="button" data-analytics-click="clear search" data-analytics-type="button" data-analytics-location="global search tool" tabindex="-1" aria-hidden="true"
style="visibility: hidden;"><span aria-hidden="true" class="close-icon">X</span></button>
</div>
</div>
<button class="autocomplete-search__submit button" type="submit" data-analytics-type="button" data-analytics-click="Search"><i class="icon-search" aria-hidden="true"></i>Search</button>
</form>GET
<form class="autocomplete-search__form" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" method="get" onsubmit="return false">
<label aria-hidden="true" class="autocomplete-search__label screenreader-only" for="autocomplete-search-1__input" id="autocomplete-search-1__label">Search</label>
<div class="autocomplete-search__combobox clear-input-field clear-input-field--initialized" id="autocomplete-search-1__combobox">
<div class="container">
<i class="icon-search" aria-hidden="true"></i>
<input type="search" class="autocomplete-search__input clear-input-textbox" maxlength="50" id="autocomplete-search-1__input" aria-labelledby="autocomplete-search-1__label">
</div>
<div class="container container--global">
<div class="autocomplete-search__listbox -hidden"></div>
<button class="clear-input-button" aria-label="Clear Search" type="button" data-analytics-click="clear search" data-analytics-type="button" data-analytics-location="global search tool" tabindex="-1" aria-hidden="true"
style="visibility: hidden;"><span aria-hidden="true" class="close-icon">X</span></button>
</div>
</div>
<button class="autocomplete-search__submit button" type="submit" data-analytics-type="button" data-analytics-click="Search"><i class="icon-search" aria-hidden="true"></i>Search</button>
</form>Text Content
Kaiser Permanente Home
Navigation Menu - Opens a Simulated Dialog
* Español
*
* Security
* Register
Support center
Region Washington
*
*
*
*
*
*
*
*
Account settings for
* Profile & Preferences
* Español
* Sign out
Region: Washington
Close Navigation Menu
* Learn
* Shop Plans
* Doctors & Locations
* Health & Wellness
* Get Care
* Pay Bills
* My Health
* Medical Record
* Message Center
* Appointments
* Pharmacy
* Coverage & Costs
* Health & Wellness
*
*
*
*
*
*
*
*
Sign in to access care
* Profile & Preferences
* Español
* Sign out
* * Español
*
Search
Search
X
Search
Search
X
Search
COVID-19 updates: Latest updates about the vaccine, booster shots, testing, how
to protect yourself and
… more
Get the latest monkeypox information, including what you need to know and what
to do if you think you’ve b
… more
Previous alert
Showing 1 of 2
Next alert
PrintOpens a dialog
REQUEST RECORDS, FORMS, & CERTIFICATIONS
ON THIS PAGE:
* Medical record request
* Radiology images
* Family and Medical Leave Act (FMLA)
* Patient questionnaires for care visits
* Restrictions on the release of health care information
* Other forms
MEDICAL RECORDS REQUEST
You have the right to view or get copies of your or your child’s medical record.
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.
Transfer a record to Kaiser Permanente
If you get care from a non-Kaiser Permanente provider, contact them to get
copies of your record, or to have your record transferred. Copies should be sent
to the Kaiser Permanente location where you will be seen.
Transfer or get a copy of your record from Kaiser Permanente
Use the following form to transfer your requested health information to a
non-Kaiser Permanente provider or facility, to another third party, or for
yourself. We accept non-Kaiser Permanente forms if they comply with federal and
state law.
Kaiser Permanente Washington Authorization for Use or Disclosure of Patient
Health Information (PDF)
Note: If you are a Washington resident and get treatment in the
Vancouver/Longview area, visit
healthy.kaiserpermanente.org/oregon-washington/support/medical-requests.
Or, if you choose to write a letter, it must include:
* The patient's signature
* Identity of the person to receive the record
* Where to send the medical record
Send your request to the appropriate regional location below:
Western Washington
Kaiser Foundation Health Plan of Washington
Centralized Release of Information, RCG-D1N-02
P.O. Box 9812
Renton, WA 98057-9054
206-630-6848 or 1-866-656-4184
Fax: 206-630-6849
Email: mailto:kpwa-roi@kp.org
Vancouver/Longview and Northern Oregon
Regional Process Center
10220 S.E. Sunnyside Road
Clackamas, OR 97015
503-571-5051
Fax: 503-571-2624
Email: mailto:nw.roi@kp.org
Central & Eastern Washington and North Idaho
Kaiser Foundation Health Plan of Washington
Centralized Health Information Management
P.O. Box 204
Spokane, WA 99224
509-241-7824
Fax: 509-232-3127
Email: mailto:kpwa-roi@kp.org
To transfer a prescription: Pharmacy Services
Processing your request
Records will be available within 15 business days. If your record is not
available within 15 days, we will let you know, and your record will be ready
within 21 days from your original request.
If the information requested does not exist or can't be found, we will let you
know within 15 business days. This is consistent with state law RCW 70.02.080
and 70.02.090.
Medical records are usually provided in electronic format. Only in emergency
situations can records be picked up. A valid photo ID is required.
If someone other than the patient picks up a record, we require a note from the
patient that specifies who may pick up the record. A valid photo ID is required.
Charges for copies
There is no charge for records sent directly to a physician, or those requested
by a patient or member.
Requests made by parties other than a patient or member may be charged a fee
consistent with WAC 246-08-400.
Your rights
You may revoke release authorization at any time by submitting a revocation form
to your health care provider, unless the provider has already acted on the
original request.
Revocation of Authorization for a Release of Information (PDF)
You have the right to request changes to your record. You also have the right to
know when information from your record has been inappropriately disclosed. You
may request restrictions on the use and disclosure of personal information.
Frequently requested forms
--------------------------------------------------------------------------------
RADIOLOGY IMAGES
Radiology images for Vancouver/Longview and Northern Oregon call 503-571-8451.
View Radiology Reports Online
You may view your radiology reports online if you have registered online and
your Kaiser Permanente doctor releases them to your online medical record.
However, digital images aren't available for members to view online at this
time.
Requesting copies
You can request copies of your radiology digital images — such as an X-ray or a
mammogram — by contacting your Kaiser Permanente clinic. Or, call the Kaiser
Permanente Radiology or Imaging Center where you had service; imaging centers
are listed below.
For echocardiogram results and digital copies, contact your cardiologist.
Echocardiograms are not provided by Radiology.
Copies of digital images are available on CD. There is no charge if you are
requesting that digital images be sent directly to a non-Kaiser Permanente
facility for your ongoing care. Charges may vary for personal copies. Ask about
charges when you call to request a copy.
How to Request Copies
You can pick up your digital images in person, have them mailed to you, or
request that they be sent to a non-Kaiser Permanente provider.
While many requests are processed the same or next day, some may take more than
72 hours (excluding weekends and holidays) to process. If you need digital
images for an appointment in the next seven business days, it is strongly
recommended you pick up your CD in person and take it to your appointment.
Fill Out Form and Show ID
To request your digital images in person, via mail, or to have them sent to a
non-Kaiser Permanente provider, you must complete and sign the Authorization to
Release Health Care Information form (PDF). To pick up your CD in person, you
must show your driver's license or other approved photo ID.
If you need someone else to pick up the CD, that person must bring a note from
you. The note should include: your full name, date of birth, and member ID
number. It should also include the full name of the person picking up the CD,
and their relationship to you. The person must show their driver's license or
other approved photo ID.
Encrypted CDs
Any CD not handed directly to a patient, a patient's legal guardian, or a person
with the patient's durable power of attorney will be encrypted according to
federal privacy laws. This means that CDs sent to a non-Kaiser Permanente doctor
will be encrypted.
Instructions are included with encrypted CDs on how to view them on a computer
compatible with Windows 2000 and later versions. The unencryption process is
fairly simple; however, if digital images will be viewed by a non-Kaiser
Permanente provider, it is recommended you pick up an unencrypted CD and take it
to your provider.
Kaiser Permanente Imaging Centers
Although you can request copies of digital images from any of our medical
centers, requests are processed faster through our imaging centers.
Bellevue Medical Center
425-502-3968
Fax: 425-502-3934
Capitol Hill Campus
206-326-3715
Fax: 206-326-2007
Everett Medical Center
425-261-1551
Fax: 425-261-1555
Olympia Medical Center
360-923-7639
Fax: 360-923-7649
Silverdale Medical Center
360-307-7491
Fax: 360-307-7367
Tacoma Medical Center
253-596-3488
Fax: 253-596-3744
--------------------------------------------------------------------------------
FAMILY AND MEDICAL LEAVE ACT (FMLA)
The Family and Medical Leave Act (FMLA) entitles employees to take unpaid time
off work for a total of up to 12 weeks for their own serious health condition or
a family member's serious health condition. FMLA defines "a serious health
condition" as any illness, injury, impairment, or physical or mental condition
that involves either inpatient care or continuing treatment by a health care
provider. To learn more about FMLA, go to the federal FMLA site.
Because some applications for family and medical leave require medical
certification, Kaiser Permanente has implemented a standardized FMLA process to
organize and streamline the review and provider certification of your FMLA
forms. Please note, additional appointments may be required if the patient has
not had a recent visit for the condition listed.
WA State Paid Family & Medical Leave (PFML)
The WA State Paid Family and Medical Leave (PFML) is a new benefit for
qualifying Washington state employees that allows paid time off for their own or
a family member’s medical condition, child bonding leave, and/or military leave.
As with FMLA, Kaiser Permanente physicians will provide a medical certification
for conditions considered medically necessary (up to 12 weeks a year). To see if
you qualify for PFML and to create an account/submit your medical certification,
go to the state PFML site.
Our FMLA/PFML process is now done electronically through your online health
record. The patient or family member requesting FMLA/PFML certification will
receive a signed, system-generated federal FMLA medical certification form
either in person, by fax, or directly from the secure member site. Patients and
family members applying for PFML will use the FMLA medical certification to
apply directly to the state website. You do not need this form if you're
adopting a child or becoming a foster parent, or for military-related events.
You also don't need it to qualify for 12 weeks of paid leave to bond with your
new baby when you or your partner give birth. (If you are the parent giving
birth, you will need the form for the portion of your paid leave that is
considered medical leave.)
1. How to submit paperwork
Download and fill out our FMLA/PFML intake form for your own condition (PDF)
or to care for your family member (PDF); we do not accept employer FMLA or
state PFML forms. Please note, the patient must be receiving care from a
Kaiser Permanente clinician.
2. If you would like to have the paperwork mailed, faxed, or picked up by a
third party, you will need to complete a Release of information form (PDF).
Note: members applying for PFML will need to create an account and upload
certification directly to the state website; Kaiser Permanente is not able
to fax requests directly.
3. Print and submit/upload the completed form(s) through your secure online
message center, by fax, or at your Kaiser Permanente medical center in
person. Find a location near you.
FMLA/PFML requests can take up to 10 business days to process. Delays in
paperwork can occur if sections of the FMLA/PFML intake form are missing or
incomplete, the required number of visits for the condition listed has not been
met, or the number of available days off has been exhausted.
If you have questions, please contact the business office at the clinic in which
you are being seen for the condition listed.
Note: Your employer's human resources team and/or third-party processing company
or WA State's Employment Security Department for PFML requests is responsible
for ultimate approval or rejection of your FMLA/PFML request. Kaiser Permanente
provides a clinical review of your request, provider's signature, and release of
FMLA medical certification form only.
More resources
* Intake form for your own condition (PDF)
* Intake form to care for a family member (PDF)
* Release of information form (PDF)
* FMLA FAQs (PDF)
--------------------------------------------------------------------------------
PATIENT QUESTIONNAIRES FOR CARE VISITS
If you were asked to fill out a questionnaire before your appointment, you may
look it up by department or specialty. Print, fill in your responses, and take
to your visit.
All questionnaires are in PDF format.
Primary Care
These questionnaires are for preventive care appointments with your primary care
provider.
* Well-Care: Preteens 10-12 (PDF)
* Well-Care: Teens 13-17 (PDF)
* Well-Care: Young Adults 18-21 (PDF)
* Well-Care: Adults 22-64 (PDF)
* Well-Care: Adults on Medicare or 65+ (PDF)
Women's Health Care/Gynecology
For visits with a women's health care provider about a health problem or
concern: Women's Health Care (PDF)
(For a preventive care visit with a women's health care provider, fill out the
appropriate questionnaire in the Primary Care section.)
For pre-natal visits with an OB/GYN (questionnaire instructions) (PDF):
Pregnancy Care (PDF)
Other Departments and Specialties
Choose your questionnaire by the department or specialty where your appointment
is scheduled.
* Allergy (PDF)
* Cardiology (PDF)
* Internal Medicine, Consultative (PDF)
* Gastroenterology (PDF)
* General Surgery (PDF)
* Mental Health and Wellness (PDF)
* Nephrology (kidney) (PDF)
* Neurology (PDF)
* Neurosurgery Spine Center (PDF)
* Oncology⁄Hematology (PDF)
* Orthopedics; North Region* (PDF)
* Orthopedics; South Region** (PDF)
* Pain Clinic (PDF)
* Physical Medicine & Rehabilitation Pain (PDF)
* Pulmonary (PDF)
* Radiation Oncology (PDF)
* Rheumatology (PDF)
* Sleep Medicine (PDF)
Medical Centers with orthopedic specialists:
*North Region: Seattle and Bellevue medical centers
**South Region: Tacoma, Olympia, Port Orchard, and Silverdale
--------------------------------------------------------------------------------
RESTRICTIONS ON THE RELEASE OF HEALTH CARE INFORMATION
State and federal laws protect certain types of information in medical records.
A specific written authorization by the patient or the patient's legally
recognized representative might be required to release these types of
information:
* Drug and alcohol abuse treatment
* Mental illness
* Sexually transmitted diseases, including HIV/AIDS
Minor patients
A competent minor patient's signature might be required to release information
related to care of:
* Mental health conditions for patients 13 years old and older
* Sexually transmitted disease and HIV/AIDS for patients 14 years old and older
* Alcohol or drug abuse for patients 13 years old and older
* Reproductive care for patients 14 years old and older
Authorized personal representatives
A legally recognized representative is an individual that may act on behalf of a
patient when a patient is not competent and cannot make his or her own health
care treatment decisions. In most cases, the personal representative needs legal
documentation to demonstrate the authority to sign for the patient. Examples of
documentation include a Durable Power of Attorney for health care or letters of
guardianship.
--------------------------------------------------------------------------------
OTHER FORMS
More resources
* Authorization to Release Health Care Information (PDF)
* Member rights and responsibilities
Back to Top
One moment
Switching to {{aocRegion}}
Find care
* Get Care
* Find Doctors & Locations
* Health Classes
* Care When Traveling
Find care
* Get Care
* Find Doctors & Locations
* Health Classes
* Care When Traveling
Our organization
* About KP
* About KP Washington
* Patient Quality & Safety
* News & Views
* Commitment to the Community
* Diversity & Inclusion
* Annual Report
* Careers
* Media Inquiries
Our organization
* About KP
* About KP Washington
* Patient Quality & Safety
* News & Views
* Commitment to the Community
* Diversity & Inclusion
* Annual Report
* Careers
* Media Inquiries
Member support
* New Member Welcome
* Interpreter Services and Accessibility
* Forms & Publications
* Support Center
* Medical Information Requests
* Patient Financial Responsibility
Member support
* New Member Welcome
* Interpreter Services and Accessibility
* Forms & Publications
* Support Center
* Medical Information Requests
* Patient Financial Responsibility
Visit our other sites
* Individual & Family Plans
* Medicaid/Medi-Cal
* Medicare
* Affordable Care Act
* For Businesses
* For Federal Employees
* Broker Support
* KP Washington Providers
Visit our other sites
* Individual & Family Plans
* Medicaid/Medi-Cal
* Medicare
* Affordable Care Act
* For Businesses
* For Federal Employees
* Broker Support
* KP Washington Providers
Language
* Español
* Other Languages
Follow Us
* twitter
* facebook
* youtube
* pinterest
* instagram
* Accessibility
* Nondiscrimination Notice
* Privacy Policy
* HIPAA Notice of Privacy Practices
* Terms of Use
* Rights & Responsibilities
* Disaster Planning
* Technical Information
* Site Map
* Contact Site Manager
Kaiser Permanente health plans around the country: Kaiser Foundation Health
Plan, Inc., in Northern and Southern California and Hawaii • Kaiser Foundation
Health Plan of Colorado • Kaiser Foundation Health Plan of Georgia, Inc., Nine
Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 • Kaiser
Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia,
and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 • Kaiser
Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100,
Portland, OR 97232 • Kaiser Foundation Health Plan of Washington or Kaiser
Foundation Health Plan of Washington Options, Inc., 1300 SW 27th St., Renton, WA
98057
Selecting these links external site icon will take you away from KP.org. Kaiser
Permanente is not responsible for the content or policies of external
websites. Details
Adobe Acrobat is required to read PDFs.
© 2022 Kaiser Foundation Health Plan, Inc.
Importante
No volver a mostrar esto.
Continuar Cancelar
Want to stay signed on?
Sign Off Stay signed on
We are unable to switch you to this area of care
Close
We’re getting your information
Close
Website Feedback