Forms and publications

Check our list of available prescription drugs or list of covered drugs.

• Learn about getting care away from home (PDF)

• Advance directives

• Appointment of Representative (AOR) form (English) – Centers for Medicare and Medicaid Services (CMS) (PDF)
• Appointment of Representative (AOR) form (Spanish) – Centers for Medicare and Medicaid Services (CMS) (PDF)
• Appointment of Representative (AOR) form in Large Font  (English) – Centers for Medicare and Medicaid Services (CMS) (PDF)
• Appointment of Representative (AOR) form in Large Font  (Spanish) – Centers for Medicare and Medicaid Services (CMS) (PDF)
• Authorization to release medical information form (Chinese) (PDF)
• Authorization to release medical information form (English) (PDF)
• Authorization to release medical information form (Spanish) (PDF)
• Behavioral Health Coordinated Opt-Out (PDF)
  
• Request for Amendment of Personal Health Information (PHI) (PDF)
• Authorization for an Adult Caregiver to Consent to Medical Care for a Child (PDF)
• Consent to Verbally Disclose Protected Health Information to Family Members and Friends (English) (PDF) 
• Consent to Verbally Disclose Protected Health Information to Family Members and Friends (Spanish) (PDF)

Note:

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

• 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.

In addition to the above HIE, Kaiser Permanente participates in the Chesapeake Regional Information System for our Patients (“CRISP”). CRISP is a regional HIE serving Maryland and Washington, D.C. You may “opt-out” and disable access to your health information available through CRISP by calling 1-877-952-7477, or by completing and submitting an opt-out form available on the CRISP website: https://connect.crisphealth.org/OptoutForm

The form may be submitted by email, mail, fax, or through the CRISP website (preferred method). Public Health Reporting, as required by law, will still occur through the HIE after you decide to opt-out and Controlled Dangerous Substances information, as part of the Maryland Prescription Drug Monitoring Program (PDMP), will also still be available to licensed providers.

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)