We share our suggestions for ordering neurological records from Kaiser Permanente Washington.
GENERAL GUIDELINES
As noted in our generic instructions for ordering neurological records from any institution, the brain bank:
- now requires that records be at the brain bank prior to the passing of the intended brain donor
- neurological records ONLY are needed. No primary care physician records or hospice records. In the cases of Parkinson’s Disease, only the most recent 6-8 years of records are needed.
- it is always easiest to download neurological records via the online patient portal. If you don’t have access to the online patient portal, records must be ordered from the medical records office or clinic. Records can be sent from medical records offices or clinics directly to the brain bank. One advantage of this approach is that there may be no fee to the family. One disadvantage of this approach is that the family has no real way to confirm that records have been sent.
- ideally, records should be sent to the brain bank by email or posted to the cloud for download by the brain bank. Second choice is by fax. Third choice is by mail with tracking. Last choice is by mail with no tracking.
- ordering records and following up with the medical records offices or clinics is the family’s responsibility
KAISER PERMANENTE WASHINGTON INFORMATION
These suggestions are derived from speaking with staff from the medical records office and viewing helpful webpages, including:
Request records, forms, & certifications
1. If you are the patient, you may choose to write a letter to the appropriate regional Kaiser Release of Information location (listed below), requesting medical records. The letter must contain:
- The patient’s signature
- Identity of the person to receive the record
- Where to send the medical record
You may submit the written letter by email, fax, or mail to the appropriate regional location below.
Your request is processed within 15 – 21 days. Records are usually delivered by electronic format.
2. If you are the patient or the patient’s legal representative, Kaiser has its own Authorization For Use Or Disclosure Of Patient Health Information form. (NOTE: Kaiser Washington will also accept non-Kaiser Permanente forms if they comply with federal and state law.)
Provide as much information as possible on the form, such as:
-> Section 2. Recipient Name:
Please enter Mayo’s information as follows:
Dennis Dickson, MD, Mayo Clinic Jacksonville
4500 San Pablo Road, Birdsall 310
Jacksonville, FL 32224-1865
Phone: 904-953-2439
Fax: 904-953-7117
Email: ℅ Rachel LaPaille-Harwood: [email protected]
Delivery Method for Records – Please check the box for Secure Email
-> Section 3. Purpose of Release:
Check the box for “Other” and add any of the following examples as the purpose for release: “medical research,” “clinical-pathological correlation” or “brain bank research.”
-> Section 4. Information From _____/_____/_____ To _____/_____/_____ To Be Released
Provide the date range for the time the patient was seen, in the fields provided. (If you do not know exact dates, you may use a broad range to capture all the appointment data.)
Beneath “To Be Released”, check the boxes for the following:
-
- Medical Records
- Radiology Reports – (if known; list type and date)
- Other (provider, department, specialty) – (add specific detail, or if there are many ask for “all neurologically-related reports”)
Be sure to sign and date the form. Unsigned forms will not be accepted.
If the intended donor is not able to sign the form, the medical power-of-attorney should sign his/her name. When you fax or email the completed authorization form, include the medical power-of-attorney document, and a legible copy of your government-issued photo ID.
You may submit the completed form by email, fax, or mail to the appropriate regional location below:
Western Washington
Kaiser Foundation Health Plan of Washington
Centralized Release of Information, RCG-D1N-02
P.O. Box 9812
Renton, WA 98057-9054
Phone: 206-630-6848 or 1-866-656-4184
Fax: 206-630-6849
Email: [email protected]
Vancouver/Longview and Northern Oregon
Regional Process Center
10220 S.E. Sunnyside Road
Clackamas, OR 97015
Phone: 503-571-5051
Fax: 503-571-2624
Email: [email protected]
Central & Eastern Washington and North Idaho
Kaiser Foundation Health Plan of Washington
Centralized Health Information Management
P.O. Box 204
Spokane, WA 99224
509-241-7824
Fax: 509-232-3127
Email: [email protected]
Your request is processed within 15 – 21 days. Records are usually delivered by electronic format.
After submitting your request, we highly encourage a follow up call to the regional ROMI department (above) to ensure the request has been processed, ask and record the date the request was completed and by what method it was sent to Mayo Clinic. This information will come in handy if Mayo has issues receiving the medical records.