For your Medical Records, please visit our Request Your Medical Record page.
For Public Records, please visit our Public Records Request page.
If you believe King County Public Hospital District No. 2 is responsible for harm or loss because of negligent actions by the District or its past or present officers, employees or volunteers, you may submit a claim for payment.
The District is required by law (chapter 4.96 RCW) to receive these claims. Some information in the form is subject to public disclosure pursuant to chapter 42.46 RCW.
Download one of these two forms:
NOTE: EMAIL IS NOT A SECURE METHOD OF DELIVERY. The District is unable to ensure that personal health or other confidential information received by email is secure according to applicable privacy laws. You should not submit any personal health or other confidential information to the District by email. If you attempt to submit an email and receive email notification that the message exceeds the domain’s maximum per-message size limit, you should try to reduce the size of the message and resend it or submit your claim by mail or in person. Your email submittal must include the date and time the claim document was submitted.
You may mail the completed form with all attachments to the following address:
EvergreenHealth
Attn: Executive Assistant to the CEO
12040 NE 128th Street, MS #14
Kirkland, WA 98034
Please keep copies of everything you submit as documents will not be returned
You may deliver the completed and signed Claim with all supporting documents to the District’s administrative offices, between 8 a.m. to 5 p.m., Monday through Friday (except holidays), located at EvergreenHealth:
Attn: Executive Assistant to the CEO
12040 NE 128th Street, Suite Silver 1800
Kirkland, WA 98034
Please keep copies of everything you submit as documents will not be returned.
District staff cannot provide legal advice; consult your attorney with questions.
The Executive Assistant to the CEO is authorized to accept service of process for King County Public Hospital District No. 2 d/b/a EvergreenHealth in the District’s administrative offices, located in Suite Silver 1800 at 12040 NE 128th Street, Kirkland, WA 98034.