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If medically appropriate, a medical certification can be submitted to an employer to determine FMLA eligibility.Ĭomplete and submit this request to your doctor to certify your serious health condition(s). If you have additional questions, click here to contact the Release of Information department for additional assistance. Please complete the steps above and include the clinician’s complete mailing address, and phone number. There may be additional charges for radiology images.There is no charge for transferring information to non-Kaiser clinicians for ongoing medical care. Third parties should supply an email address to receive password-encrypted medical records.

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Third parties requesting records are charged $16.50, representing the average cost of producing records, plus sales tax, if applicable. Please contact us via email at or phone at 50 for cost information. Additional pages are subject to a per-page printing fee and shipping costs via secure carrier. If printed records are required, up to 25 pages are provided free of charge. Send the completed, signed form, and payment (if required, see below) via email, or postal mail to:Įmail: Kaiser Permanente Release of Information Department 10220 SE Sunnyside Road, Clackamas, OR 97015Įlectronic records are provided free of charge to patients, whether current or former members. Complete and sign in ink the Authorization for Kaiser Permanente to Use/Disclose Protected Health Information (PDF).

If you want your medical records sent to a third party, including a family member, your signature is required.

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If you aren’t certain if your email address on file is correct, please contact Membership Services to update your records. 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.

Clearnace forms to go back to work pdf#

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. Send an email to identifying yourself with name, birthdate, health record number, and phone number. Records not available on kp.org can be sent to you upon request.

Clearnace forms to go back to work download#

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.

Access your record by doing the following: Order an electronic copy of your detailed medical records.Ĭurrent and former KP members can access most of their medical records from Kaiser Permanente Northwest at any time from kp.org. Note that Hospital and Medical Office records released as part of this request may contain references related to mental health, addiction, and HIV conditions. Allow 5 business days for the completion of your request. You can specify the date range, which medical records, and the party receiving the copy of your medical records. Bright holds a Bachelor of Science in psychology from the University of North Carolina-Pembroke and a Master of Arts in psychology-marriage and family therapy from Brandman University.Order an electronic copy of my detailed medical records. He works for a mental health non-profit in Northern California. Paul Bright has been writing online since 2006, specializing in topics related to military employment and mental health. Consider obtaining a credit report prior to completing the clearance form.

Be sure to answer all questions honestly and to the best of your knowledge.

Incorrect answers pertaining to past criminal history or delinquent credit may cause investigators to question your trustworthiness.Recently separated military members who had a current clearance and less than two years break in service may not need to complete another clearance check.Ask your human resource representative or SSO if they utilize e-QIP. The e-QIP computer program allows for online clearance application.Incomplete forms can result in security clearance delays or rejection.