Va form 10 5345a 2025

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The document outlines the process for individuals to request a copy of their health information from the Department of Veterans Affairs (VA) under the Privacy Act and Paperwork Reduction Act. It includes instructions for completing the request form, which takes an estimated 2 minutes, and emphasizes the voluntary nature of providing personal information, including Social Security Number, necessary for locating records.

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Where do I send VA form 10 5345a?

How to submit a medical records request. 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.

What is a VA medical release form 10 5345?

Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization.

Where do I send my VA form 10 5345A?

Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.

Where do I send my VA apportionment form?

After completing the form, mail to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.

How do I release medical records to the VA?

Requests for preauthorization can be made to the Health Administration Center by mail: VA Health Administration Center, PO Box 469065, Denver, Colorado 80246-9065 or, if the service is urgent, telephone (833-930-0816), or FAX (303-331-7807).

10 5345a form

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