In general, Kaiser Permanente - Oregon/Washington operates on a system where primary care physicians typically manage referrals for specialty care. However, members can receive care without a referral in certain circumstances. For instance, members might have direct access to specific types of services or providers, depending on their health plan. It is important for members to review the specifics of their plan, as some services may allow for direct appointments without the need for a referral. For the most accurate and detailed information about your particular plan and the requirements for seeing a physician, it is best to consult the member materials available on the Kaiser Permanente website. There you can find guidelines that pertain to your health plan and any necessary steps for accessing care.