VA Release 2025

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The document is a request form for the authorization to release medical records or health information from the Department of Veterans Affairs. It outlines the legal framework under which the information can be disclosed, including compliance with privacy laws. The form requires the patient's name, Social Security Number, and details about the information being requested, such as treatment notes related to specific conditions like alcoholism or drug abuse. It also specifies that providing this information is voluntary but necessary for processing requests. The purpose of the disclosure is primarily for underwriting a life insurance application.

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Click ‘Get Form’ to open the VA Release in the editor.
Begin by entering the patient's name and Social Security Number if the patient data card imprint is not used. This information is crucial for locating records.
In the 'To' section, specify the name and address of the health care facility or individual to whom the information will be released.
Indicate your request by checking applicable boxes for conditions such as alcoholism, drug abuse, or HIV testing. Provide details about the information requested, including dates covered.
State the purpose for which this information will be used, such as underwriting a life insurance application.
Sign and date the authorization section to certify that your request is made voluntarily and accurately. Ensure you understand your rights regarding revocation of this authorization.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (42 Votes)
2020	4.8 Satisfied (269 Votes)
2005	4.4 Satisfied (324 Votes)
2005	4.4 Satisfied (76 Votes)
2003	4.2 Satisfied (102 Votes)

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