Medical Records Request

We encourage patients and their representatives to take advantage of the MyChart Patient Portal. MyChart gives you instant access to their electronic medical record, where you can see records like After Visit Summaries, medications, immunizations. Click here to sign up for MyChart.

If you would like to request your own/your child’s medical records from Kapa’a Pediatrics please complete the following steps:

  1. Please complete the following - Authorization to Release Protected Health Information

  2. Drop off or send the completed form to Kapa’a Pediatrics, LLC via Email, Fax, or Mail

  3. If you would like to send Kapa’a Pediatrics, LLC records from another provider it is best to contact them for their specific Authorization to Release Protected Health Information Form.

Fee Notice: If the requested medical records are not going to another health care facility there may be a fee for printing out the medical chart.


Should you wish to mail your form, please mail to:

Kapa’a Pediatrics, LLC
c/o Health Information Management
4-1461 Kuhio Hwy.
Kapaa, HI 96746

If you have questions about requesting medical records, please contact us at (808) 634-8011 or email us at kp@kapaapediatrics.com.