Kaiser Permanente Confidential Communication Request Form 2025

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The Privacy Rule, a Federal law, gives you rights over your health information and sets rules and limits on who can look at and receive your health information. The Privacy Rule applies to all forms of individuals protected health information, whether electronic, written, or oral.
Patient rights under HIPAA encompass the right to access and obtain copies of their health information, the right to request corrections to their records, the right to receive privacy notices, the right to control the sharing of their health information, the right to file complaints about privacy violations, the right
please contact our member services department at 1-800-464-4000 they will be able to guide you through this process. To submit a request to amend or correct information in your medical record, please complete the patient amendment request form below: Patient Amendment Request - English (PDF)
(i) A covered health care provider must permit individuals to request and must accommodate reasonable requests by individuals to receive communications of protected health information from the covered health care provider by alternative means or at alternative locations.
Patient confidentiality refers to the right of patients to keep their records private and represents physicians and medical professionals moral and legal obligations in handling patients sensitive medical and personal information.

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The confidential communications request shall apply to all communications that disclose medical information or provider name and address related to receipt of medical services by the individual requesting the confidential communication.

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