Submit request to Release of Information: Mail: Kaiser Permanente Attn: ROI 501 Alakawa Street, 2nd Floor Honolulu, HI 96817. Fax: (866) 609-7402. Email: [email protected]. . . Please describe the specific records you’re requesting to help us respond more completely to your request. (Example: Related to a condition or surgery, specific lab tests, all available records, etc.). o This section is optional. Enter additional details as desired related to the types of records you need.You can order food & coffee ahead for pickup while you're here at the Los Angeles Medical Center. Located at 4733 Sunset on the 2nd floor. Kaiser Permanente Los Angeles Medical Center Achieves Magnet® Recognition. LA County facility receives highest national honor for nursing excellence. Your feedback helps us and other members.Established in 1945. Founded in 1945, Kaiser Permanente is recognized as one of America's leading health care providers and nonprofit health plans. We currently serve 12.6 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group …Scheduled phone visits. Schedule an appointment to talk with your doctor, a specialist, or an available clinician over the phone. Average wait time. Varies by region of care. Hours. Varies by region of care. Check to see if same-day or next-day appointments are available. Upfront cost. for KP members.Have questions about how to access care, request an interpreter, get medical forms and records, manage your health online, and more. If you have an urgent health concern that requires prompt medical attention, but isn't an emergency, call 866-454-8855 for 24/7 advice. If you think you have a medical or mental health emergency, call 911 or go to ...In today’s digital age, it is important to stay informed about how your phone number is being used and tracked. Knowing the basics of phone number tracking can help you protect you...Submit the completed Kaiser Permanente forms & your Disability paperwork. When you have completed the steps above, email all paperwork to [email protected], fax all paperwork to (770) 220-3705 or mail to Kaiser Permanente Georgia, Medical Records Administration, 3200 Breckinridge Blvd, Duluth, Georgia 30096.Kaiser Permanente has made it easy for our members to request their Medical Rec- ... San Diego Release of Information Unit Phone: 619-583-4293 Email: [email protected] ...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 ...Custom Care & Coverage Just For You | Kaiser PermanenteEstablished in 1945. Founded in 1945, Kaiser Permanente is recognized as one of America's leading health care providers and nonprofit health plans. We currently serve 12.6 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group …Fax: 206-630-6849 Fax: 509-232-3127. To request Radiology Images ONLY (x-rays, MRI’s, CT’s, mammograms etc.), please send requests to: Kaiser Foundation Health Plan of Washington Central Imaging Center 201 16th Ave E Seattle, WA 98112. Phone: 206-326-3715 Fax: 206-326-2007.Find your VA health facility. On your health facility’s website, scroll to the “In the spotlight” box. Select “Access your health records.”. This will bring you to a page with contact information for the medical records office. Note: If you get care at a Community Based Outpatient Clinic (CBOC) or Outpatient Clinic (OPC), call the ...Kaiser Permanente members entering ... ROMI (Release of Medical Information) Phone number: 916-746-3646 ... Kaiser Permanente health plans around the country: ...Member Services. Members who require assistance can call our Member Services Contact Center. 800-464-4000 or TTY 711 (English) 800-788-0616 (Spanish)Email: [email protected]. Telephone Option. 619-583-4293. Telephone hours are Monday- Friday from 9am-4pm. We are closed all Major Holidays. San Diego ROI Unit is committed to providing you the best possible service. Below are some of the services we can assist with. Medical Certifications.Kaiser Permanente Redwood City Medical Center is a comprehensive health care facility that offers a range of services, from urgent care to acupuncture, for members and non-members alike. Whether you need prompt attention for an illness or injury, or you want to improve your wellness and prevention, you can find quality care and support at our … Email form to the Release of Information Department at [email protected]. o Member section of the form must be completed prior to submission. Please include medical record number & date of birth on all correspondence. o This applies to any form requiring a physician’s medical opinion and signature, other than State Disability or FMLA certification. Visit Napa Medical Offices for personalized care and coverage from Kaiser Permanente. Explore our departments, services and location details.Are you a former Kaiser Permanente member? If you are a former member and need records or other forms, call our Release of Information office at (303) 404-4700. Back to Top. Submit a medical request online, or find information about how to request medical care from Kaiser Permanente.MAIL OR IN PERSON. Santa Clara Valley Medical Center. Health Information Management Department. Release of Information. 751 S. Bascom Ave., Room 1C037. San Jose, CA 95128. The Health Information Management Services (Medical Records) Department is located on the first floor of SCVMC, across from Elevator C.Kaiser Permanente Renton Campus. 2921 Naches Ave SW, Mail Stop RCR-A3S-05. Renton, WA 98057. For authorization requests, procedure notifications, authorization logs, etc. 1-800-289-1363. Fax: 1-888-282-2685. For DME authorization requests, quotes, and orders: Fax: 1-877-290-4632. For medical records and clinical review information:Have questions about how to access care, request an interpreter, get medical forms and records, manage your health online, and more. If you have an urgent health concern that requires prompt medical attention, but isn't an emergency, call 866-454-8855 for 24/7 advice. If you think you have a medical or mental health emergency, call 911 or go to ...Location: 39000 Bob Hope Drive, Wright Building, Suite 104, Rancho Mirage, CA 92270. Phone: 760-773-1211. Fax: 760-773-2020. For assistance with diagnostic images for studies conducted at Eisenhower Imaging Center (EIC), please call the EIC’s Medical Records team at 760-674-3876. For assistance with MyChart activation, MyChart proxy, or ... Facilities, Departments and Services in Napa-Solano. Everybody is different and every member unique, which is why when it comes to taking care of your health, you have access to a wide range of services, no matter your age, lifestyle, or situation. Fairfield Medical Offices. 1550 Gateway Blvd. Fairfield, CA 94533-6900. Kaiser Permanente Redwood City Medical Center is a comprehensive health care facility that offers a range of services, from urgent care to acupuncture, for members and non-members alike. Whether you need prompt attention for an illness or injury, or you want to improve your wellness and prevention, you can find quality care and support at our …Check ONLY one of the following three options to identify the health information to be released. Option 1: Form Completion (a substitute form or relevant medical records may be released) Option 2: Last 2 years of Kaiser Permanente Medical Ofice and Kaiser Foundation Hospital records. Option 3: Records as specified. Submit the completed Kaiser Permanente forms & your Disability paperwork. When you have completed the steps above, email all paperwork to [email protected], fax all paperwork to (770) 220-3705 or mail to Kaiser Permanente Georgia, Medical Records Administration, 3200 Breckinridge Blvd, Duluth, Georgia 30096. Stockton Medical Offices. 7373 West Lane, Stockton, CA 95201. 209-476-2000. Map & Directions Departments Find a Doctor.Kaiser Permanente Redwood City Medical Center is a comprehensive health care facility that offers a range of services, from urgent care to acupuncture, for members and non-members alike. Whether you need prompt attention for an illness or injury, or you want to improve your wellness and prevention, you can find quality care and support at our … information, mental health information and genetic testing information. PATIENT SIGNATURE AUTHORIZING RELEASE PLEASE PRINT & SIGN USING BLUE OR BLACK INK (No electronic signatures will be accepted) DATE/TIME Release of Information Department 10220 SE Sunnyside Rd., Clackamas, OR 97015-9764 Phone: 503-571-5051 Fax: 503-571-2624 Kaiser Permanente Hawaii Region - Authorization for Release of Protected Health Information. HAWAII REGION. 3288 Moanalua Road, Honolulu, HI 96819 Phone: (808) 432‐5092 Fax: (808) 432‐5070. Kaiser Permanente Hawaii Region - Authorization for Release of Protected Health Information. HAWAII REGION. 3288 Moanalua Road, Honolulu, HI 96819 Phone: (808) 432‐5092 Fax: (808) 432‐5070.Contact our Release of Medical Information (ROMI) Department for help with forms for medical leave, schools, or other organizations.MAIL OR IN PERSON. Santa Clara Valley Medical Center. Health Information Management Department. Release of Information. 751 S. Bascom Ave., Room 1C037. San Jose, CA 95128. The Health Information Management Services (Medical Records) Department is located on the first floor of SCVMC, across from Elevator C.Orange County offers care and coverage, together, to help make life easier. Combining cutting-edge technology with a focus on prevention, Kaiser Permanente Orange County puts you and your health at the heart of everything we do to help you get healthy, stay healthy, and thrive. Highlighting our community health work in Southern California.Birth certificates are issued by the Los Angeles County Department of Public Health. AVMC provides pertinent information to the county, which is used to create the official birth certificate. You can obtain a copy from the Los Angeles County Registrar‑Recorder/County Clerk. Contact AVMC Medical Records. Phone: 661-949-5011 Fax: 661-949-5017View, download, or print commonly used forms, guidebooks, handbooks, and other publications. Please tell us your location so we can take you to information customized for that area. Find care. Our organization. Member support.RELEASE OF MEDICAL INFORMATION DEPARTMENT INTAKE ADDRESS MAIN PHONE NUMBER DEPARTMENT EMAIL ADDRESS. Antelope Valley. Lancaster Medical Offices Palmdale Medical Offices Santa Clarita Medical Offices Antelope Valley Release of Information Unit 43112 N. 15thStreet West Lancaster, CA 93534. [email protected] Baldwin Park.Release of Information MAILSTOP: RCG-D1N-02 PO Box 9010 Renton, WA 98057-9054 Phone: 206-630-6848 or toll-free 1-866-656-4184 Hours: 8 a.m. to 5 p.m. Email: [email protected] Fax:877-848-6896. Eastern Washington Kaiser Foundation Health Plan of Washington Release of Information MAILSTOP: ACN-AC3 PO Box 204 Spokane, WA … Make sure you’re registered for and signed in to your own online Kaiser Permanente account. If your child is a Kaiser Permanente member but you aren’t, contact Member Services for assistance at 1-888-901-4636 (TTY 711). Fill out and submit the request parental access form. Check ONLY one of the following three options to identify the health information to be released. Option 1: Form Completion (a substitute form or relevant medical records may be released) Option 2: Last 2 years of Kaiser Permanente Medical Ofice and Kaiser Foundation Hospital records. Option 3: Records as specified.Kaiser Permanente Redwood City Medical Center is a comprehensive health care facility that offers a range of services, from urgent care to acupuncture, for members and non-members alike. Whether you need prompt attention for an illness or injury, or you want to improve your wellness and prevention, you can find quality care and support at our …How to transfer your medical records. Oct 13, 2021. To make your transition to Kaiser Permanente of the Mid-Atlantic as seamless as possible, please bring the following to your first appointment*: A list of your allergies, medications, medical conditions, surgeries, cancer screening tests, and. immunizations.Option 1: Form Completion (a substitute form or relevant medical records may be released) Option 2: Last 2 years of Kaiser Permanente Medical Ofice and Kaiser Foundation Hospital records. Option 3: Records as specified. You must …This question is about the Kohl's Credit Card @p_danes • 10/31/22 This answer was first published on 12/03/21 and it was last updated on 10/31/22.For the most current information a...NOTE: I understand that the medical information released bythis authorization may include information concer ning treatment of physical or mental illness ...Mobile navigation. Select a region. Santa Rosa. Sign on at kp.org. external page. ... Release of Medical Information (ROMI) Resources for Senior Health; Rheumatology; S. ... Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii • Kaiser Foundation Health Plan of ...Contact us. Requests to the Release of Information Department: Due to COVID, we accept mail & email only at this time. In all correspondence, please include the name, date of birth, and health record number of the person who received care. Email: [email protected] Phone: 503-571-5051 (8 am to 4:30 pm, Monday through Friday), Toll Free: 800-813-2000 ...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 ...Contact our Release of Medical Information (ROMI) Department for help with forms for medical leave, schools, or other organizations.Release of Medical Information Is now virtual! RELEASE OF MEDICAL INFORMATION How to Contact Us: On kp.org, it is easy to access your health information when you need it. You can ... To request an electronic copy of your medical records, please contact us Monday – Friday between 8:30 am and 5:00 pm at: Email: [email protected] ONLY one of the following three options to identify the health information to be released. Option 1: Form Completion (a substitute form or relevant medical records may be released) Option 2: Last 2 years of Kaiser Permanente Medical Ofice and Kaiser Foundation Hospital records. Option 3: Records as specified.Are you trying to find out who owns a phone number? If so, you’re not alone. With the rise of telemarketing and scam calls, it’s becoming increasingly important to know who is call...Option 1: Form Completion (a substitute form or relevant medical records may be released) Option 2: Last 2 years of Kaiser Permanente Medical Ofice and Kaiser Foundation Hospital records. Option 3: Records as specified. You must complete Step 1 and Step 2 below. Step 1.Make sure you’re registered for and signed in to your own online Kaiser Permanente account. If your child is a Kaiser Permanente member but you aren’t, contact Member Services for assistance at 1-888-901-4636 (TTY 711). Fill out and submit the request parental access form.; Parents also may make this request at the office of their child's …Contact Member Services Choose from the following contact options for questions and concerns about your plan, benefits, billing, account management, and more. Important : If you think you or someone you care for is having a medical or mental health emergency, call 911 or go to the nearest hospital.Ambulatory Student and Shadowing Programs. Departments and Specialties. Member Services. Pharmacy Services. Release of Medical Information (ROMI) Lathrop Mental Health and Wellness Center. Modesto-Enterprise Mental Health and Wellness Center. St. Joseph's Medical Center. Dale Road Medical Offices.Use the Kaiser Permanente Central Valley Departments & Services list to find the department you are looking for. ... Release of Medical Information (ROMI) Modesto-Enterprise Mental Health and Wellness Center. 4700 Enterprise Way Modesto, CA 95356 More about this location >Request for Access to Protected Health Information . Release of Information • Phone: 303-404-4700 • Fax: 303-404-4750 . Patients must submit a request, in writing, to obtain copies or to view their own protected health information. This form is also to be used for a parent or guardian requesting access to the records of a minor.Mental health care advice. Specialty care referrals. Don’t use this for. Emergency care. Urgent care. Schedule a phone visit. Schedule a phone appointment to talk with your doctor, a specialist, or an available clinician.Contact us. Requests to the Release of Information Department: Due to COVID, we accept mail & email only at this time. In all correspondence, please include the name, date of birth, and health record number of the person who received care. Email: [email protected] Phone: 503-571-5051 (8 am to 4:30 pm, Monday through Friday), Toll Free: 800-813-2000 ...RELEASE OF MEDICAL INFORMATION. Release of Medical Information 2nd Floor, Dept. 200 Marshall Medical Offices 905 Maple St Redwood City, CA 94063 (Enter underground parking from Marshall Ct.) Campus Maps . Email [email protected]. Phone 650-299-3228. Hours 9:00 a.m. – 5:00 p.m. Closed 12:30 p.m. – 1:30 p.m. for lunch. Your RecordsWe would like to show you a description here but the site won’t allow us.In today’s digital age, it is important to stay informed about how your phone number is being used and tracked. Knowing the basics of phone number tracking can help you protect you...In today’s digital age, having a phone number is essential for communication. However, traditional phone services can come with hefty charges and monthly fees. Fortunately, there a...Release of Information MAILSTOP: RCG-D1N-02 PO Box 9010 Renton, WA 98057-9054 Phone: 206-630-6848 or toll-free 1-866-656-4184 Hours: 8 a.m. to 5 p.m. Email: [email protected] Fax:877-848-6896. Eastern Washington Kaiser Foundation Health Plan of Washington Release of Information MAILSTOP: ACN-AC3 PO Box 204 Spokane, WA 99210-9809 Phone: 509-241-7824Getting the WellCare phone number can take some extra research, especially if you don’t know where to look. Fortunately, there are several easy ways to get the number quickly and e...Kaiser Permanente Hawaii Region - Authorization for Release of Protected Health Information. HAWAII REGION. 3288 Moanalua Road, Honolulu, HI 96819 Phone: (808) 432‐5092 Fax: (808) 432‐5070.Complete any required section (s) of the form or certification prior to submission. If the form is for a specific condition or medication, please provide this information. Send a secure message to Medical Records via KP.org: In the subject line dropdown list, select “Medical Records, Forms, or Doctor’s Note”. Attach your requested form.Complete and sign a Confidential Communications Request form (see the link below), and send it to: Attn: Member Services, P.O. Box 34590, Seattle, WA 98124. Complete and sign the Confidential Communications Request form, and fax it to 1-888-874-1765. Contact Member Services at 1-888-901-4636 and ask for assistance.OF PATIENT HEALTH INFORMATION. ORIGINAL - DISCLOSING PARTY. CANARY - PATIENT. Kaiser Foundation Hospitals. Permanente Medical Groups. NS-9934 (2-11) HIPAA COMPLIANT SPANISH-NS-1614; CHINESE-NS-6274 90258 (REV. 2-11) SPANISH 01782-000; CHINESE 01782-002. Kaiser Permanente will not condition treatment, …Release of Information MAILSTOP: RCG-D1N-02 PO Box 9010 Renton, WA 98057-9054 Phone: 206-630-6848 or toll-free 1-866-656-4184 Hours: 8 a.m. to 5 p.m. Email: [email protected] Fax:877-848-6896. Eastern Washington Kaiser Foundation Health Plan of Washington Release of Information MAILSTOP: ACN-AC3 PO Box 204 Spokane, WA …Click here to see the many ways you can get care when it works for you — whether 24/7 advice, online e-visits or video visits, phone, or in-person. INFORMATION TO JOIN KAISER PERMANENTE Employer group plansPatient Name: Medical Record number: Birth Date: Address: City: State: Zip Code: Phone #:. Email: Kaiser Permanente may release this information to: ...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 ...View, download, or print commonly used forms, guidebooks, handbooks, and other publications. Please tell us your location so we can take you to information customized for that area. Find care. Our organization. Member support.Contact our ROMI Departments and track requests. For your convenience, you may contact ROMI by phone or email. You can view the status of your existing requests online, including medical records and FMLA and SDI certifications. Locate the …How to transfer your medical records. Oct 13, 2021. To make your transition to Kaiser Permanente of the Mid-Atlantic as seamless as possible, please bring the following to your first appointment*: A list of your allergies, medications, medical conditions, surgeries, cancer screening tests, and. immunizations.Visit Napa Medical Offices for personalized care and coverage from Kaiser Permanente. Explore our departments, services and location details.Location: 39000 Bob Hope Drive, Wright Building, Suite 104, Rancho Mirage, CA 92270. Phone: 760-773-1211. Fax: 760-773-2020. For assistance with diagnostic images for studies conducted at Eisenhower Imaging Center (EIC), please call the EIC’s Medical Records team at 760-674-3876. For assistance with MyChart activation, MyChart proxy, or ... Fax: 206-630-6849 Fax: 509-232-3127. To request Radiology Images ONLY (x-rays, MRI’s, CT’s, mammograms etc.), please send requests to: Kaiser Foundation Health Plan of Washington Central Imaging Center 201 16th Ave E Seattle, WA 98112. Phone: 206-326-3715 Fax: 206-326-2007. Check ONLY one of the following three options to identify the health information to be released. Option 1: Form Completion (a substitute form or relevant medical records may be released) Option 2: Last 2 years of Kaiser Permanente Medical Ofice and Kaiser Foundation Hospital records. Option 3: Records as specified.ORIGINAL - DISCLOSING PARTY. CANARY - PATIENT. Kaiser Foundation Hospitals. Permanente Medical Groups. NS-9934 (2-11) HIPAA COMPLIANT SPANISH-NS-1614; CHINESE-NS-6274 90258 (REV. 2-11) SPANISH 01782-000; CHINESE 01782-002. Kaiser Permanente will not condition treatment, payment, enrollment or.Facilities, Departments and Services in Napa-Solano. Everybody is different and every member unique, which is why when it comes to taking care of your health, you have access to a wide range of services, no matter your age, lifestyle, or situation. Fairfield Medical Offices. 1550 Gateway Blvd. Fairfield, CA 94533-6900.What Is the Phone Number for Kaiser Member Services? Current members of non-Medicare Kaiser Permanente plans can call 1-800-966-5955 to reach Kaiser member services, which is a general Kaiser Permanente customer service department.. The hours of operation for this phone number are Monday through Friday from 8 a.m. to 5 …2500 Merced Street, San Leandro, CA 94577. 510-454-1000. Map & Directions Campus Map Departments Visitor Information Find a Doctor.
Complete any required section (s) of the form or certification prior to submission. If the form is for a specific condition or medication, please provide this information. Send a secure message to Medical Records via KP.org: In the subject line dropdown list, select “Medical Records, Forms, or Doctor’s Note”. Attach your requested form. . Cvs pharmacy tricare
Contact Member Services Choose from the following contact options for questions and concerns about your plan, benefits, billing, account management, and more. Important : If you think you or someone you care for is having a medical or mental health emergency, call 911 or go to the nearest hospital.NOTE: These instructions assume the caregiver has already registered for their own account on kp.org. To use kp.org on behalf of an adult member. Sign in to kp.org and go to Act for a Family Member. (You can also find it in your Profile & Preferences on kp.org, located under My Account.) Under People you're taking care of, select Add an adult to …At Kaiser Permanente South San Francisco Medical Center, you can get quality care from a team of doctors, nurses, and specialists. Whether you need a routine checkup, a prescription refill, or a COVID-19 test, you can schedule online or by phone. Learn more about our services and how we can help you thrive.Use the Kaiser Permanente Fresno Departments & Services list to find the department you are looking for. Skip to page main content Skip to page footer. Fresno. ... Release of Medical Information (ROMI) First Street Medical Offices. 4785 N. First St. Fresno, CA 93726 More about this location > Addiction Medicine Recovery Services; Advice Nurse; Medical Forms, Records, and Certifications. Working with our doctors, our Release of Medical Information (ROMI) Department helps you complete forms for disability or medical leave and provide required medical information to your school, employer, or other organization. 1. . . Please describe the specific records you’re requesting to help us respond more completely to your request. (Example: Related to a condition or surgery, specific lab tests, all available records, etc.). o This section is optional. Enter additional details as desired related to the types of records you need.Check ONLY one of the following three options to identify the health information to be released. Option 1: Form Completion (a substitute form or relevant medical records may be released) Option 2: Last 2 years of Kaiser Permanente Medical Ofice and Kaiser Foundation Hospital records. Option 3: Records as specified.Signature of Representative Date Relationship. . Check if patient is a minor Keep a copy for your records and submit the original to: Kaiser Permanente Appeals, P.O. Box 34593, Seattle, WA 98124-1593. Please contact Member Appeals at 1-866-458-5479 if you need a copy of this form. AG1000097-01-17 Kaiser Foundation Health Plan of Washington.Instructions: 1) Complete the patient identification information on the top right-hand corner. 2) Complete all required information for the recipient including a valid email address. 3) Check the box for purpose of disclosure. 4) Check the box(es) for the type of information to be disclosed and also check the box for a timeframe.Information about a practitioner is provided to us by the practitioner or is obtained as part of the credentialing process. If you have questions, please call ...OF PATIENT HEALTH INFORMATION. ORIGINAL - DISCLOSING PARTY. CANARY - PATIENT. Kaiser Foundation Hospitals. Permanente Medical Groups. NS-9934 (2-11) HIPAA COMPLIANT SPANISH-NS-1614; CHINESE-NS-6274 90258 (REV. 2-11) SPANISH 01782-000; CHINESE 01782-002. Kaiser Permanente will not condition treatment, …Release of Medical Information Is now virtual! RELEASE OF MEDICAL INFORMATION How to Contact Us: On kp.org, it is easy to access your health information when you need it. You can ... To request an electronic copy of your medical records, please contact us Monday – Friday between 8:30 am and 5:00 pm at: Email: [email protected] Forms, Records, and Certifications. Working with our doctors, our Release of Medical Information (ROMI) Department helps you complete forms for disability or medical leave and provide required medical information …Under Member support, click Medical Information Requests. You will be directed to a page titled Records, forms and certifications. Find what you need in the list of links at the top of the page: Click Medical records to request your electronic medical record. Click Immunization record to view and print your current immunization status.Release of Information MAILSTOP: RCG-D1N-02 PO Box 9010 Renton, WA 98057-9054 Phone: 206-630-6848 or toll-free 1-866-656-4184 Hours: 8 a.m. to 5 p.m. Email: [email protected] Fax:877-848-6896. Eastern Washington Kaiser Foundation Health Plan of Washington Release of Information MAILSTOP: ACN-AC3 PO Box 204 Spokane, WA … Check ONLY one of the following three options to identify the health information to be released and be specific. Option 1: Option 2: Option 3: Step 2. Select types of records to be released: NOTE: related to mental health, addiction, and HIV medical conditions. Check the boxes below if you want this release to include the following information ... OF PATIENT HEALTH INFORMATION. ORIGINAL - DISCLOSING PARTY. CANARY - PATIENT. Kaiser Foundation Hospitals. Permanente Medical Groups. NS-9934 (2-11) HIPAA COMPLIANT SPANISH-NS-1614; CHINESE-NS-6274 90258 (REV. 2-11) SPANISH 01782-000; CHINESE 01782-002. Kaiser Permanente will not condition treatment, …Check ONLY one of the following three options to identify the health information to be released. Option 1: Form Completion (a substitute form or relevant medical records may be released) Option 2: Last 2 years of Kaiser Permanente Medical Ofice and Kaiser Foundation Hospital records. Option 3: Records as specified.You can return your completed form by: Faxing it to 808.242.2538. Mailing it to: Maui Memorial Medical Center, 221 Mahalani St., Wailuku, HI 96793, Attn: Health Information Management — Release of Information. If you have questions, please call the Medical Records office at 808.442.5213. You can access information about your hospital stay or ....
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