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How to use or fill out kaiser permanente medical records fax number southern california with DocHub
- Click ‘Get Form’ to open it in the editor.
- Begin by imprinting your Kaiser Permanente ID card in the designated area at the top of the form.
- Fill in the 'REQUEST Medical Information FROM' section with the name of your healthcare provider and their address.
- In the 'SEND Medical Information TO' section, provide the name and address of the person or entity that will receive your medical information.
- Complete the patient identification fields, including your name, address, medical record number, date of birth, and telephone number.
- Specify which records you want released by checking the appropriate boxes and providing any necessary date ranges.
- Sign and date the authorization at the bottom of the form. If applicable, indicate your relationship if signing on behalf of another person.
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