Records, forms, and certification

 

Request and access medical information for yourself and your family

You have the right to view or get copies of your or your child’s medical record. You can view them online or request electronic copies if you get care at a Kaiser Permanente medical office. You can also request your health information be sent to any person or entity.

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.

Subpoenas, Court Orders and other legal requests for records of Kaiser Permanente of Washington patients may be submitted by fax or email to Release of Information at 877-848-6896 or kpwa-roi@kp.org. This is consistent with WA state law RCW 70.02.060 and court rules CR 5 (7).

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.

Radiology images for Vancouver/Longview and Northern Oregon call 503-571-8451.

View Radiology Reports Online

You may view your radiology reports online if you have registered online and your Kaiser Permanente doctor releases them to your online medical record. However, digital images aren't available for members to view online at this time.

Requesting copies
You can request copies of your radiology digital images — such as an X-ray or a mammogram — by contacting your Kaiser Permanente clinic. Or, call the Kaiser Permanente Radiology or Imaging Center where you had service; imaging centers are listed below.

For echocardiogram results and digital copies, contact your cardiologist. Echocardiograms are not provided by Radiology.

Copies of digital images are available on CD. There is no charge if you are requesting that digital images be sent directly to a non-Kaiser Permanente facility for your ongoing care. Charges may vary for personal copies. Ask about charges when you call to request a copy.

How to Request Copies
You can pick up your digital images in person, have them mailed to you, or request that they be sent to a non-Kaiser Permanente provider.

While many requests are processed the same or next day, some may take more than 72 hours (excluding weekends and holidays) to process. If you need digital images for an appointment in the next seven business days, it is strongly recommended you pick up your CD in person and take it to your appointment.

Fill Out Form and Show ID
To request your digital images in person, via mail, or to have them sent to a non-Kaiser Permanente provider, you must complete and sign the Authorization to Release Health Care Information form (PDF). To pick up your CD in person, you must show your driver's license or other approved photo ID.

If you need someone else to pick up the CD, that person must bring a note from you. The note should include: your full name, date of birth, and member ID number. It should also include the full name of the person picking up the CD, and their relationship to you. The person must show their driver's license or other approved photo ID.

Encrypted Emails
Any email not handed directly to a patient, a patient's legal guardian, or a person with the patient's durable power of attorney will be encrypted according to federal privacy laws. This means that emails sent to a non-Kaiser Permanente doctor will be encrypted.


Instructions are included with encrypted emails on how to view them on a computer compatible with Windows 2000 and later versions. The unencryption process is fairly simple; however, if digital images will be viewed by a non-Kaiser Permanente provider, it is recommended you pick up an unencrypted email and take it to your provider.

Kaiser Permanente Imaging Centers
Although you can request copies of digital images from any of our medical centers, requests are processed faster through our imaging centers.


Bellevue Medical Center 
425-502-3968
Fax: 425-502-3934


Capitol Hill Campus 
206-326-3715
Fax: 206-326-2007


Everett Medical Center 
425-261-1551
Fax: 425-261-1555


Olympia Medical Center
360-923-7639
Fax: 360-923-7649


Silverdale Medical Center 
360-307-7491
Fax: 360-307-7367


Tacoma Medical Center 
253-596-3488
Fax: 253-596-3744

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:

  • The patient's signature
  • Identity of the person to receive the record
  • Where to send the medical record

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

Please visit the Records, forms, and certificates page for Oregon/SW Washington region.


To transfer a prescription: Pharmacy Services

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.

If you were asked to fill out a questionnaire before your appointment, you may look it up by department or specialty. Print, fill in your responses, and take to your visit.

All questionnaires are in PDF format.

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:

  • Drug and alcohol abuse treatment
  • Mental illness
  • Sexually transmitted diseases, including HIV/AIDS

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:

  • Sexually transmitted diseases including HIV (ages 14-17)
  • Mental health and addiction recovery services (ages 13-17)
  • Reproductive care (all minors)

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.

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

  1. Complete the electronic FMLA and PFML questionnaire through the member’s online account, or download and fill out our FMLA/PFML intake form for your own condition (PDF) or to care for your family member (PDF);  we do not accept employer FMLA or state PFML forms. Please note, the patient must be receiving care from a Kaiser Permanente clinician.
  2. If you would like to have the paperwork mailed, faxed, or picked up by a third party, you will need to complete a Release of information form (PDF). Note: members applying for PFML will need to create an account and upload certification directly to the state website; Kaiser Permanente is not able to fax requests directly.
  3. Print and submit/upload the completed form(s) through your secure online message center, by fax, or at your Kaiser Permanente medical center in person. Find a location near you.

FMLA/PFML requests can take up to 7 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.

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