Kaiser Permanente Authorization Form - Web a copy of this authorization is as valid as an original. Individual (name and information of person whose health. Authorization for use and/or disclosure of member/patient health information imprint area. Web authorization to disclose health plan information. Web authorization for use or disclosure of patient health information | kaiser permanente washington author: I have the right to receive a copy of this authorization.
Authorization for use and/or disclosure of member/patient health information imprint area. I have the right to receive a copy of this authorization. Web a copy of this authorization is as valid as an original. Web authorization to disclose health plan information. Individual (name and information of person whose health. Web authorization for use or disclosure of patient health information | kaiser permanente washington author: