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KAISER PERMANENTE Kaiser Foundation Hospital Southern California Permanente Medical Group AUTHORIZATION FOR RELEASE AND / OR DISCLOSURE OF MEDICAL INFORMATION IMPRINT KAISER PERMANENTE ID CARD HERE Treatment payment enrollment or eligibility for benefits will not be conditioned on my providing or refusing to provide this authorization. Please REQUEST Medical Information FROM Please SEND Medical Information TO Name of Health Care Provider Name of Person or Entity to Receive Information Name of...

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Music hello my name is Lisa change immigrationofficials keep a file or archive at eachperson this may include borderapprehensions or immigration courtrecords you may obtain a copy of thisfile by filing a FOIA request FOIAstands for freedom of information act tolearn more information about how to filea FOIA request please contact me at 7 158 430 800 thank you Music