Forms and publications

• Annual notices (PDF)
• Consumer choice option (English) (PDF)
• Consumer choice option (Spanish) (PDF)

• Travel brochure (PDF)
• Visiting member brochure (PDF)

• Advance directives

• Authorization for Kaiser Permanente to release information (Chinese) (PDF)
• Authorization for Kaiser Permanente to release information (English) (PDF)
• Authorization for Kaiser Permanente to release information (Spanish) (PDF)
• Medicare AOR (English) (PDF)
• Medicare AOR (Spanish) (PDF)
• Medicare AOR Large Font (English) (PDF)
• Medicare AOR Large Font (Spanish) (PDF)

• Format of disclosure and intent to pay charge (PDF)
• Release of information fees: Pursuant to O.C.G.A. 31-33-3, below is a breakdown of the pricing structure for costs related to medical record retrieval, certification, and copying in accordance with State of Georgia guidelines.

Medical Record Copies (Paper)*
 

Medical Record Copies (Electronic)*
 

*Additional rates may apply for record requests necessary to complete applications for Social Security, Worker’s Compensation, and legal requests.

• Find out how Kaiser Permanente shares important medical information

Learn how Kaiser Permanente shares important medical information as part of Health Information Exchange.

At Kaiser Permanente, knowing your medical history, such as your active medications and allergies, is critical to help ensure that you receive high-quality care. Advancements in technology support safe and secure electronic exchange of important clinical information from one health care provider to another, through Health Information Exchange (HIE) networks.

Kaiser Permanente operates an HIE network among its regions and participates in several HIE networks with trusted outside health care providers who have electronic medical record systems.

HIE participants like Kaiser Permanente are required to comply with specific federal and state laws that protect the privacy and security of your health and personal information. For example, we cannot share sensitive health information, including psychotherapy notes and records of substance abuse, through the HIE without first obtaining your written authorization.

Under the Health Insurance Portability and Accountability Act (HIPAA), Kaiser Permanente can legally share your health information with your other care providers for the purposes of treatment and care coordination. It is important for your care providers to have timely access to this information so that they have a complete picture of your medical history, reducing the likelihood of conflicting diagnoses, prescriptions, and treatment plans as well as repeated tests or procedures.

For more information, visit the HIE Frequently Asked Questions (FAQ) document available below or contact the Member or Customer Services number on the back of your ID card with any questions.

• Frequently asked questions about Health Information Exchange (PDF)