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Maryland, Virginia, Washington, D.C.

Find authorization of care forms for you or a loved one.

Get advance directives and authorization to release medical information forms.

Note:

If you are a Medicare member submitting a request or a complaint, you must also submit a Disclosure authorization form along with your Medicare AOR form.

If you think there is something inaccurate or incomplete in your medical record, you can request an amendment to your medical record.

Health Information Exchange (HIE)

  • Find out how Kaiser Permanente shares important medical information

    Learn how Kaiser Permanente shares important medical information as part of Health Information Exchange. You can opt out of the exchange by completing the “Health Information Exchange Opt Out Form” below.

    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. Recent advancements in technology now support the 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 also 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.

    Participation in HIE is completely your choice. You can choose to not have your information shared electronically through any of our HIE networks (“opt out”) at any time, by filling out the “Health Information Exchange Opt-Out” form available below and returning it to the fax number or address provided on the bottom form.

    Please note that if you opt out, the health care providers treating you are still permitted to contact us to ask that your health information be shared with them through other means, such as by fax.

    Opting out does not prevent information from being shared between members of your care team.

    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.

  • Health Information Exchange Opt-In Form
  • Health Information Exchange Opt-Out Form
  • Frequently asked questions about Health Information Exchange

Use these forms to file claims for care.

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Medical information requests

You can request copies of medical records, forms, certifications, and other documents. Learn more.