Records, forms and certifications


On this page:


Health summary

A basic summary of your online health record. It meets most needs, including changing your physician or switching to another health plan. Learn more.


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 Northwest, 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.

Current and former KP members can access most of their medical records from Kaiser Permanente Northwest at any time from kp.org. Access your record by doing the following:

  • Log in to kp.org and choose Medical Record from the menu at the top.
  • Select from options on the menu on the left side of the screen and follow the onscreen prompts to view and/or download the most commonly requested medical records, including immunizations, test results, visit summaries, and hospital records.

Records not available on kp.org can be sent to you upon request. Send an email to nw.roi@kp.org identifying yourself with name, birthdate, health record number, and phone number. Supply a date range for the records you need, and they will be sent to your email address on file in a secure password-encrypted PDF format. You will be able to open the file on any computer or smart phone and have the ability to search it, print it, or forward it. If you aren’t certain if your email address on file is correct, please contact Membership Services to update your records.


If you want your medical records sent to a third party, including a family member, your signature is required. Complete and sign in ink the Authorization for Kaiser Permanente to Use/Disclose Protected Health Information (PDF).


Send the completed, signed form, and payment (if required, see below) via email, or postal mail to:


Email: nw.roi@kp.org
Mail: Kaiser Permanente Release of Information Department 10220 SE Sunnyside Road, Clackamas, OR 97015

Cost of records
Electronic records are provided free of charge to patients, whether current or former members. If printed records are required, up to 25 pages are provided free of charge. Additional pages are subject to a per-page printing fee and shipping costs via secure carrier. Please contact us via email at nw.roi@kp.org or phone at 503-571-5051 for cost information.

Third parties requesting records are charged $16.50, representing the average cost of producing records, plus sales tax, if applicable. Third parties should supply an email address to receive password-encrypted medical records.
There may be additional charges for radiology images.There is no charge for transferring information to non-Kaiser clinicians for ongoing medical care. Please complete the steps above and include the clinician’s complete mailing address, and phone number.

Still have questions?
If you have additional questions, click here to contact the Release of Information department for additional assistance.


Work leave and accommodations

If medically appropriate, a medical certification form can be submitted to an employer or leave administrator to determine your eligibility for:

  • Family and Medical Leave Act (FMLA)
  • Oregon Family Leave Act (OFLA)
  • Paid Leave Oregon (PLO)
  • Washington Paid Family and Medical Leave (PFML)

FMLA and OFLA protect your absence from work due to a serious health condition to care for yourself or an eligible family member. PLO and PFML provide financial benefits in addition to work leave protection.

All four programs accept the federal FMLA medical certification form Kaiser will provide. No other forms are required. Refer to your employer or leave administrator for details on your organization’s policies on timing for requesting leave and how to submit your form.

Click the link below to request medical certification. Do not submit forms for medical certification (FMLA, OFLA, PLO, or PFML) directly to your clinician. Requests submitted through the link below will be routed to your clinician for review. The amount of time certified is based on in-depth review of your medical record and may not always reflect your original request.

Request FMLA medical certification

Patients who do not have their own kp.org account or are unable to access kp.org through their personal login and password information must request medical certification by completing and submitting this Intake form to nw.roi@kp.org. Intake form available in Russian and Spanish below, under Other Authorizations, Consents, and Request Forms.

These definitions will assist you in making your request:

Continuous leave: A leave of more than three (3) consecutive days for your own serious health condition or to care for a family member with a serious health condition.

Intermittent leave: Leave taken in separate blocks of time due to a serious health condition, such as flare-ups of a chronic condition. You must provide details about the frequency of flare-ups, e.g., number of episodes per month and duration of episodes. A reduced work schedule also falls under intermittent leave.

Parental leave for baby bonding: Parental leave is an entitlement and does not require medical certification nor is your clinician’s signature required. You only need to provide proof of birth, such as a birth certificate, hospital discharge paperwork, or after-visit summaries.

Modification of an existing leave: If any of the above requests require modification after they have already been approved, please contact your clinical team to have your work status updated.

Short-term and long-term disability coverage protect employees when they are off the job for a period of time due to illness or injury. These benefits are typically provided through an insurance carrier designated by your employer, who will supply you with a form. Kaiser will substitute a universal attending physician statement that your disability carrier will accept.

Complete the following:

  • Submit the form provided to you by your disability carrier.
  • INCLUDE a completed Intake form (PDF) to initiate your STD/LTD request. Intake form available in Russian and Spanish below, under Other Authorizations, Consents, and Request Forms.
  • INCLUDE a signed authorization form to permit the transmission of your completed form(s) to your insurance carrier. Clear photographs of forms are acceptable.
  • INCLUDE your disability claim number on the Intake form.
  • Email all forms to nw.roi@kp.org. Clear photographs of forms are acceptable.

Forms submitted with incomplete information will significantly delay processing of your request.

If you are on leave for a continuous period of time, you may need medical clearance from your clinician before you return to work. If you require a release to return to work, please complete the following steps:

  • Contact your clinical team via kp.org message to request a Work Status Report or “return to work” note, or make this request by phone to your clinical team (obtain their phone number via kp.org or by calling 503-813-2000 or 800-813-2000). In some cases, you may need to schedule an appointment. In your Work Status Report, your clinician may specify any potential limitations you require during your transition to regular duties.
  • Your clinician will make your Work Status Report available as a letter on kp.org or make arrangements for you to pick it up.
  • You are responsible for providing your release to your employer.

Under the Americans with Disabilities Act (ADA), employers are required to provide reasonable accommodations to qualified employees with disabilities, unless doing so would pose an undue hardship. A reasonable accommodation is defined as assistance or changes to a position or workplace that will enable an employee to do his or her job despite having a disability.

If you require an accommodation, please complete the following steps:

  • Contact your employer, who will either provide a document for your clinical team to complete or direct you on next steps. In some cases, you may need to schedule an appointment.
  • If you are given a form by your employer, use kp.org to message your clinical team or call them (obtain their phone number via kp.org or by calling 503-813-2000 or 800-813-2000) for further instructions.

Do not send ADA paperwork to the Release of Information department as that will delay your request.


Still have questions?
Click here to contact the Release of Information department for additional assistance.


Immunization record

Your record of immunizations can be used for school, camp, and other needs.


All other forms and authorizations

If you have a form described here, it needs to be completed by your clinician.

Do not send these forms to the Release of Information department as that will delay your request.

A visit may be required for the items below depending upon your request. Please email your clinical team via kp.org for further instructions. You can also find their phone number by calling 503-813-2000, or 800-813-2000 or via kp.org to call them for further instructions.

Request types include but are not limited to:

  • Seniors and Caregivers – Adult Day Services, Assisted Living Facility (ALF) Orders, Death Certificate, Hospice, Independent Senior Housing, Senior Nursing Facility, SilverSneakers and/or Silver & Fit
  • Child or Dependent Care – Adoption, Children with Disabilities, Headstart, School-related Treatment Plans
  • Health Status Statements – Job Corps, Jury Duty, Plasma Donations, Hunting/Fishing
  • Physical Care and Support - PGE Medical Emergency Certification, Pet Accommodations, TriMet Disabled Rider, Non-Kaiser Permanente Dental Medical Clearance

Complete the following:

— Please email your clinical team via kp.org for further instructions on your specific form request. You can also find their phone number by calling 503-813-2000 or 800-813-2000 or via kp.org to call them for further instructions.

— Do not send these forms to the Release of Information department as that will delay your request.

Records to support managing care and treatment that you may want included in your medical record need to be sent to:

Kaiser Permanente Medical Records
10220 SE Sunnyside Road
Clackamas, OR 97015

These records may include but are not limited to:

  • Medical Records from Non-Kaiser Permanente Clinicians or Health Care providers
  • Advance Directives

Still have questions?
If you have additional questions, click here to contact the Release of Information department for additional assistance.

Other Authorizations, Consents, and Request Forms

My requests

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


Frequently asked questions


Questions about work leave and accommodations:
Q: How do I submit a form or request?

A: For forms related to a work leave, such as FMLA or disability, or for a work accommodation, click here.

For all other types of forms, it is best to first reach out to your clinical team. Email your clinical team via kp.org or locate their phone number via kp.org to call them for further instructions or call 503-813-2000 or 800-813-2000.

Q: What if I have questions before I submit my request or form?
A: Call or email us. You’ll find contact information here.
Q: Do I give my form to my clinician?

A: Forms related to FMLA, short-term disability, or long-term disability cannot be completed in the clinician’s office and must be routed to the Release of Information Department. Click here for more information.

For other types of forms, it is best to speak with your clinical team. Email your clinical team via kp.org, or locate their phone number via kp.org to call them for further instructions or call 503-813-2000 or 800-813-2000.

Q: How long should I expect for my request to be fulfilled?

A: We process forms in the order received. Employers are required to allow at least 15 days for an employee to return a FMLA certification, and we will make every effort to meet that deadline with FMLA certifications as well as with short-term and long-term disability forms. Please be aware that incomplete forms will delay your return of your request. In addition, authorization must be provided on the intake form if the completed form is to be sent to anyone other than you, the patient. If the authorization is not signed, the completed form will be sent to the patient. Click here for complete instructions on FMLA and Short and Long-term Disability requests.

All other forms will be clinician dependent, please contact your clinical team for further instructions. Email your clinical team via kp.org, or locate their phone number via kp.org to call them for further instructions or call 503-813-2000 or 800-813-2000.

Q: What if my form is incorrect or my clinician declines to sign it?
A: If your form was approved with different parameters or not approved, contact your clinician for an explanation. You may need to schedule a telephone appointment with your clinician.
Q: How do I receive my completed form?
A: When you request your form, you specify where it should be sent and by what method, including email, fax, or postal mail. Click here for complete instructions on completing the request.

Questions about requesting medical records
Q: I need medical records, what do I do?
A: To request copies of your medical records, click here for complete instructions. If you should have further questions please do not hesitate to call or email us so we may provide clarity.
Q: Can I have my medical records sent to someone other than myself?
A: You can designate any recipient as well as the delivery method. Click here for complete instructions.
Q: How long does it take to receive my medical records?
A: Record requests are completed in the order received. The time it takes to process a request depends upon the location and format of the records (paper or electronic) and the format and method by which they are to be provided. Click here for complete instructions. In general, medical record requests are completed within 30 days for Oregon residents and 15 days for Washington residents, as required by law. If you have an urgent need, please contact us and we will assist you in meeting your needs. Our contact information can be found here.
Q: Where can I get X-Ray images?

A: For images (films) other than dental or eyes, call the Imaging department at 503-571-8451, email your request to NW-imaging-ROI@kp.org, or fax it to 503-571-8469. If images are to be sent to a third party who is not a treatment provider, you must provide an Authorization for Use or Disclosure of Protected Health Information signed by the patient. The Imaging department transmits images via a download portal or on CD/DVD.

For dental or eye images only, send your request to the ROI department at nw.roi@kp.org or call 503-571-5051. The ROI department discloses images via email or a download portal. Here are helpful documents for accessing images through the portal: Patient Guide and PowerShare Mobile App.

Q: How do I have my prior medical records added to my Kaiser Permanente record?
A: Contact your prior physician(s) to understand their process for sharing medical records. Ask them to send your records to Kaiser Permanente Medical Records, 10220 SE Sunnyside Road, Clackamas, OR 97015 or fax to 877-849-4116 or via email to nw-med-rec@kp.org .
Q: Can I come to the Release of Information department to view my records?
A: You can access many of your medical records via kp.org or we can provide your medical records to you electronically or on paper so that you can review them in the privacy of your home. If you have questions about the content of your records, you can meet with your clinician for an explanation. To request your medical records, click here for complete instructions.

General questions
Q: I think I found an error in the information I received. Who do I contact to answer my questions or get it fixed?
A: Contact us here and we will assist you.
Q: I am having problems opening the secure attachment in my email. Who do I call?
A: Call 866-529-0776 for assistance with our Secure File Transfer system.
Q: My form or records were emailed to me but I am not seeing anything from you in my inbox. What do I do?
A: Check your spam or bulk mail folder first, then contact us here. We will verify your email address and resend information, if necessary. Note that protected health information is sent via Secure File Transfer. You will receive an email asking you to register for a password that enables you to download your records.
Q: How can I find out who has seen my medical records?
A: The HIPAA Privacy Rule gives you the right to receive an accounting of disclosures made of your protected health information. To receive this information, complete and submit the Request for Disclosure Accounting Report form, which is located at the bottom of the Other Forms and Authorizations page, click here. The Disclosure Accounting Report form includes information about the disclosure accounting process, including what the report includes, what it does not include, cost, and how long it takes to receive the report.
Q: I still have questions!
A: No problem! Please reach out to our team and we are happy to help. You’ll find contact information here.


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: nw.roi@kp.org
Phone: 503-571-5051 (8 am to 4:30 pm, Monday through Friday), Toll Free: 800-813-2000
Mail:
500 NE Multnomah Street, Suite 100
Portland, OR 97232-2099

Requests to your clinical team:

Email your clinical team via kp.org for further instructions. You may also find their phone number by calling 503-813-2000 or 800-813-2000 or via kp.org to call them for further instructions.

Still not sure who to contact with your questions? Email or call the Release of Information department using the contact information above, we would be happy to assist you.