Records, forms and certifications

On this page:

Health summary

A PDF summary of your online health records, including allergies, immunizations, ongoing health conditions, medications, test results, and some procedures. Additionally, it includes changing your physician or switching to another health plan. Download your health summary.

You may also request your records and other documents by phone or Order an electronic copy of your detailed medical records online. You can find your local Release of Medical Information department contact information.

Medical records

Immediately download certain health information.

Visit my medical records to view and print your or your family members’ most commonly requested medical records and reports from Kaiser Permanente Mid-Atlantic States, including the following:

Order an electronic copy of my detailed medical records.

You can specify the date range, which medical records, and the party receiving the copy of your medical records. Allow 5 business days for the completion of your request. Note that Hospital and Medical Office records released as part of this request may contain references related to mental health, addiction, and HIV conditions. Order an electronic copy of your detailed medical records.

• Copay summary
  You can request a summary of your copays for pharmacy and office visits. Request your copay summary.

Family Medical Leave Act (FMLA)

To request physician certification for family and medical leave, please submit this request. Request FMLA medical certification.

Other Forms

The medical records department can assist you with forms that you may need filled out from another organization.

Before we can do this, you will need to:

• 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        

Once received, your request will be processed including obtaining any physician signatures.

Itemized billing

You can request a summary of your itemized billing – a list of the out-of-pocket costs you’ve paid for health care, by doing the following:

• Fill out an Authorization To Use And Disclose Protected Health Information form (PDF) and
• Send a secure message to Medical Records by clicking here and attach the Authorization to Use And Disclose Protected Health Information (PDF) to your message.
  

Please call Health Information Management Services for assistance.

Disability (private insurance) certification

We assist your physician in completing your disability certification.

Before we can do this, you will need to:

• Discuss your disability and needs with your physician.
• Get a doctor’s note for the time you will need to be off work.

Once you have completed the above steps send a secure message to Medical Records with the following information:

• Condition (Injury/ Illness)
• Date of onset of condition
• Date of upcoming surgery (if applicable)
  

Please call Health Information Management Services for assistance.

Doctor's note/Return to work form

We can provide you with a doctor’s note or return-to-work form, allowing you to return to your job after an illness or injury.

Before we can do this, please send a secure message to Medical Records with the following information:

• If there are any restrictions that need to be include. If yes, please state specific restrictions.
• The type of work you do
• The specific dates that your doctor’s note or return to work form are pertaining to
• Attach any forms (if applicable)

Please call Health Information Management Services for assistance.

Immunization record

Get a list of immunizations for you or your child. You can download your official immunization certificate for use with school entry, camp, or for an employer. Print your official immunization record here.

Forms and publications

View, download, and print commonly used forms, handbooks, and other publications.

Health Information Management Services locations

Phone numbers for Health Information Management Services.

My requests

Track your requests for Medical Records, Family Medical Leave Act (FMLA) Medical Certification requests.

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