Common Contracts
1 similar Kaiser Permanente contracts
Release and Consent Agreement – For Photos, Audio, Name, and Creative Works (INCLUDES HIPAA AUTHORIZATION: Use This 3-page Form Where Member/Patient Health Information Will Be Disclosed)Kaiser Permanente • November 6th, 2020
I, ____________________________________ (print name), in exchange for valuable consideration* received, hereby irrevocably consent to the unrestricted use for or by Kaiser Foundation Health Plan, Inc. (“KFHP”), Kaiser Foundation Hospitals (“KFH”), the Permanente Medical Groups, and each of their affiliates and subsidiaries and their respective directors, officers, employees, agents, customers, successors and assigns (collectively “KP”) of the following (mark below only those items that you are releasing):
