Kaiser medical released 2025

1. Click ‘Get Form’ to open the kaiser medical released document in the editor.
2. Begin by entering your Patient Name, Medical Record number, and Birth Date in the designated fields. Ensure accuracy for proper identification.
3. Fill in your Address, City, State, Zip Code, and Phone Number. This information is crucial for communication regarding your request.
4. Specify the recipient of the health information by filling out their Name, Address, City, State, Zip Code, Phone Number, and Email if applicable.
5. Select the purpose of this disclosure by checking one of the options provided such as Personal Use or Medical Treatment.
6. Choose one of the three options to identify the health information you wish to release. If selecting Option 3, complete Step 1 and Step 2 below it.
7. For Option 3, enter the date range or specific dates for records needed and select types of records from the list provided.
8. Indicate if you want to include sensitive information like Mental Health Treatment Records by checking the appropriate boxes.
9. Select your preferred Media Type (Electronic or Paper) and Delivery Preference (Electronic, Mail, or Pickup).
10. Finally, sign and date the form at the bottom to authorize the release of your health information.

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