Records, forms and certifications


On this page:


Medical records

Order an electronic copy of my detailed medical records.

If you need a copy of your medical record for yourself or those you care for – or to share with another health care provider – you can:

  • Download a summary copy that includes allergies, immunizations, ongoing health conditions, medications, test results, procedures, and more. Download health summary here.
  • Request a detailed copy of your medical record to be sent to you through secure email within 5 days or less. Request your medical record.
  • Imaging records (x-rays, scans, ultrasounds), except for dental or eye films, must be requested from the Imaging department. Call 503-571-8451 for information.
  • 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.

Former members will need to click Register at the top of the page to reactivate their account.

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.

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

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, 500 NE Multnomah Street, Suite 100, Portland, OR 97232-2099

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 Permanente 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 Permanente 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.

If YOU are the patient (not a proxy), read the instructions below then click the link Request FMLA Medical Certification to enter your request. If you are a proxy, call 503-571-5051 to make the request.

  1. Do not submit forms directly to your clinician. Requests submitted through the link below or via phone 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.
  2. The completed form will appear in the patient’s KP.org account in the Letters section within 7 days. An email notification will be sent to the patient via KP.org.
  3. To direct the form to a third party, use the third-party distribution option when completing your request or follow the instructions supplied in a phone request.
  4. HOW TO DOWNLOAD A MEDICAL CERTIFICATION FORM FROM KP.org:

    1. Log into your KP.org account on a computer or on a mobile phone using the web browser. Do not use the KP mobile app, as it does not support printing.
    2. Choose Medical Record and then the Letters section.
    3. Select the document named FMLA Letter. It is 4 pages in length with a red, white, and blue logo in the upper right corner of the first page.
    4. Choose Print and select PDF format.
    5. Save the form to your computer or mobile phone files, renaming it as needed so you can locate it when you either attach it to an email or upload it to your state paid leave website.
    6. If you are using a mobile phone and cannot see the Print command, turn the phone sideways to landscape view as the Print command is in the upper right corner and may not be visible in portrait view.

Request FMLA Medical Certification

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 Permanente 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 the first date you were unable to work and the day you expect to be able to return to work.
  • INCLUDE the name of the disabling condition.
  • 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 if you have one.
  • 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
500 NE Multnomah Street, Suite 100
Portland, OR 97232-2099

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.


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.