About VA Form 10-5345a 2025

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This document is a form for individuals to request a copy of their health information from the Department of Veterans Affairs (VA) in compliance with privacy regulations. It outlines the necessary personal information required for the request, including patient details and specific types of health records desired. The form emphasizes that providing accurate information is essential for processing the request and clarifies that failure to do so will not affect other benefits.

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What is a VA medical release form 10 5345?

The form authorizes release of information in ance with the Health Insurance Portability and Accountability Act, 45 CFR Parts 160 and 164; 5 U.S.C. 552a; and 38 U.S.C. 5701 and 7332 that you specify. Your disclosure of the information requested on this form is voluntary.

What is the purpose of VA form 10 5345?

The form authorizes release of information in ance with the Health Insurance Portability and Accountability Act, 45 CFR Parts 160 and 164; 5 U.S.C.

What does the VA consider medical evidence?

Youll need to submit current evidence from a medical professional that shows your disability has gotten worse. Submit at least one of these types of documents: Medical records or medical opinions from health care providers. Lay evidence, like a buddy statement (VA Form 21-10210)

What is VA form 10 5345a used for?

Youll need to fill out an Individuals Request for a Copy of Their Own Health Information (VA Form 10-5345a). Submit your completed form to your VA health facilitys medical records office. This office is also called a Release of Information Office. You can submit your form by mail, by fax, or in person.

What is the VA release form for medical records?

If you change your mind and want to share your health information, youll need to submit VA Form 10-10163 (Request for and Permission to Participate in Sharing Protected Health Information). Mail the signed, completed form to our ROI office. You can also bring it with you or ask for this form when you visit us.

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What is a medical release form for?

What does constitute a medical release form? The form gives healthcare professionals permission to share a patients medical information with certain other parties. HIPAA regulations refer to it as an authorization.

About VA Form 10-5345a 2025

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What is a VA medical release form 10 5345?

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