Kaiser Permanente Mid-Atlantic States fax number

Fax destination details

Department

Health Information Management Services (HIMS) / Release of Information

Purpose

Medical records requests / Release of Information (HIPAA) to disclose health information to a recipient

Form

HIPAA Authorization / Authorization for Use or Disclosure of Protected Health Information — Authorization for Use or Disclosure of Protected Health Information

Address

Kaiser Permanente Mid-Atlantic States, 4000 Garden City Drive, Hyattsville, MD 20785

Voice phone

1-800-777-7904, option 2

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Complete patient and recipient details, specify the health information to be released, purpose, delivery method, and duration; sign and date; submit to Kaiser Permanente’s Release of Information (ROI) per region (fax: 1-240-632-4177). Note: sensitive data (e.g., mental health, HIV) may have additional handling requirements.

Official form instructions are published as a downloadable file on the organization's website.