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Authorization for Medical Care
Please fax completed form with supporting documentation to 877-800-5456. Pre-authorization requests must be submitted by a healthcare provider. If you have any questions about the pre-authorization request form, the pre-authorization process, or what services require pre-authorization, please call us at the phone number below. Kaiser Permanente NW Regional Referral Center: 503-813-4560 or 1-866-813-2437 

Eligibility Verification Form
The Eligibility Verification Form is a template that can be used when provider offices need to verify the eligibility of numerous Kaiser Permanente Northwest members.

Explanation of Payment (EOP)
The Kaiser Permanente Explanation of Payment is sent to providers to inform them of how a claim was adjudicated.

Laboratory Requisition Form
Please use the attached form when ordering Laboratory Services from Kaiser Permanente.   
For questions regarding Laboratory Services, contact Laboratory Client Services at 503-258-6900.

Specialty Radiology Form♦ and Radiology Form
Please use the attached forms when ordering Radiology Services from Kaiser Permanente.

Drug Coverage Request Form♦ 
Please prescribe formulary medication(s) for your patients with Kaiser Permanente benefits. To view our formulary, visit If a formulary medication is not appropriate, complete the Drug Coverage Request Form and Fax to 1-866-618-6569

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