If you get care from a non-Kaiser Permanente provider, contact them to get copies of your record, or to have your record transferred. Copies should be sent to the Kaiser Permanente location where you will be seen.
Use the following form to transfer your requested health information to a non-Kaiser Permanente provider or facility, to another third party, or for yourself. We accept non-Kaiser Permanente forms if they comply with federal and state law.
Kaiser Permanente Washington Authorization for Use or Disclosure of Patient Health Information (PDF)
Note: If you are a Washington resident and get treatment in the Vancouver/Longview area, visit healthy.kaiserpermanente.org/oregon-washington/support/medical-requests.
Or, if you choose to write a letter, it must include:
Send your request to the appropriate regional location below:
Western Washington
Kaiser Foundation Health Plan of Washington
Release of Information, RCR-A3E-01
P.O. Box 9010
Renton, WA 98057-9010
Phone: 1-866-656-4184
Fax: 877-848-6896
Email: kpwa-roi@kp.org
Eastern Washington
Kaiser Foundation Health Plan of Washington
Release of Information, RFM-W200C2
P.O. Box 204
Spokane, WA 99210-0204
Phone: 509-241-7824
Fax: 855-414-1751
Email: kpwa-roi@kp.org
Vancouver/Longview and Northern Oregon
Regional Process Center
10220 S.E. Sunnyside Road
Clackamas, OR 97015
Phone: 503-571-5051
Fax: 503-571-2624
Email: nw.roi@kp.org
To transfer a prescription: Pharmacy Services
Records will be available within 15 business days. If your record is not available within 15 days, we will let you know, and your record will be ready within 21 days from your original request.
If the information requested does not exist or can't be found, we will let you know within 15 business days. This is consistent with state law RCW 70.02.080 and 70.02.090.
Medical records are usually provided in electronic format. Only in emergency situations can records be picked up. A valid photo ID is required.
If someone other than the patient picks up a record, we require a note from the patient that specifies who may pick up the record. A valid photo ID is required.
There is no charge for records sent directly to a physician, or those requested by a patient or member.
Requests made by parties other than a patient or member may be charged a fee consistent with WAC 246-08-400.
You may revoke release authorization at any time by submitting a revocation form to your health care provider, unless the provider has already acted on the original request.
Revocation of Authorization for a Release of Information (PDF)
You have the right to request changes to your record. You also have the right to know when information from your record has been inappropriately disclosed. You may request restrictions on the use and disclosure of personal information.
Radiology images for Vancouver/Longview and Northern Oregon call 503-571-8451.
The Family and Medical Leave Act (FMLA) entitles employees to take unpaid time off work for a total of up to 12 weeks for their own serious health condition or a family member's serious health condition. FMLA defines "a serious health condition" as any illness, injury, impairment, or physical or mental condition that involves either inpatient care or continuing treatment by a health care provider. To learn more about FMLA, go to the federal FMLA site.
Because some applications for family and medical leave require medical certification, Kaiser Permanente has implemented a standardized FMLA process to organize and streamline the review and provider certification of your FMLA forms. Please note, additional appointments may be required if the patient has not had a recent visit for the condition listed.
WA State Paid Family & Medical Leave (PFML)
The WA State Paid Family and Medical Leave (PFML) is a new benefit for qualifying Washington state employees that allows paid time off for their own or a family member’s medical condition, child bonding leave, and/or military leave. As with FMLA, Kaiser Permanente physicians will provide a medical certification for conditions considered medically necessary (up to 12 weeks a year). To see if you qualify for PFML and to create an account/submit your medical certification, go to the state PFML site.
Our FMLA/PFML process is now done electronically through your online health record. The patient or family member requesting FMLA/PFML certification will receive a signed, system-generated federal FMLA medical certification form either in person, by fax, or directly from the secure member site. Patients and family members applying for PFML will use the FMLA medical certification to apply directly to the state website. You do not need this form if you're adopting a child or becoming a foster parent, or for military-related events. You also don't need it to qualify for 12 weeks of paid leave to bond with your new baby when you or your partner give birth. (If you are the parent giving birth, you will need the form for the portion of your paid leave that is considered medical leave.)
How to submit paperwork
FMLA/PFML requests can take up to 15 days to process. Delays in paperwork can occur if sections of the FMLA/PFML intake form are missing or incomplete, the required number of visits for the condition listed has not been met, or the number of available days off has been exhausted.
If you have questions, please contact the business office at the clinic in which you are being seen for the condition listed.
Note: Your employer's human resources team and/or third-party processing company or WA State's Employment Security Department for PFML requests is responsible for ultimate approval or rejection of your FMLA/PFML request. Kaiser Permanente provides a clinical review of your request, provider's signature, and release of FMLA medical certification form only.
More resources
These questionnaires are for preventive care appointments with your primary care provider.
For visits with a women's health care provider about a health problem or concern: Women's Health Care (PDF)
(For a preventive care visit with a women's health care provider, fill out the appropriate questionnaire in the Primary Care section.)
For pre-natal visits with an OB/GYN (questionnaire instructions) (PDF):
Pregnancy Care (PDF)
Choose your questionnaire by the department or specialty where your appointment is scheduled.
Medical Centers with orthopedic specialists:
*North Region: Seattle and Bellevue medical centers
**South Region: Tacoma, Olympia, Port Orchard, and Silverdale
State and federal laws protect certain types of information in medical records. A specific written authorization by the patient or the patient's legally recognized representative might be required to release these types of information:
Minor patients
Minor patients have the right to control certain types of healthcare information. They may be required to sign an authorization to release this information:
Authorized personal representatives
A legally recognized representative is an individual that may act on behalf of a patient when a patient is not competent and cannot make his or her own health care treatment decisions. In most cases, the personal representative needs legal documentation to demonstrate the authority to sign for the patient. Examples of documentation include a Durable Power of Attorney for health care or letters of guardianship.
More resources
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