Kaiser Medical Release Form
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Kaiser Medical Release Form
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Kaiser Permanente will not condition treatment payment enrollment or eligibility for benefits on providing or refusing to provide this authorization To q Produce a copy of medical records as specified below q Complete form s Please specify form Telephone number type s in the PURPOSE section below q Medical Forms, Records, and Certifications. Working with our doctors, our Release of Medical Information (ROMI) Department helps you complete forms for disability or medical leave and provide required medical information to.
Kaiser Medical Release FormRequest records, forms, & certifications. Please tell us your location so we can take you to information customized for that area. Submit a medical request online, or find information about how to request medical care from Kaiser Permanente. Option 1 Form Completion a substitute form or relevant medical records may be released Option 2 Last 2 years of Kaiser Permanente Medical Ofice and Kaiser Foundation Hospital records Option 3 Records as specified You must complete Step 1 and Step 2 below Step 1