Va form 10230a 2025

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Use VA Form 21p-8416 to report medical or dental expenses that you have paid for yourself or for a family member living in your household. These must be expenses you werent reimbursed for and dont expect to be reimbursed for.
The Department of Veterans Affairs encourages all Veterans to submit their private medical records for consideration during the processing of their benefits claim. VA values evidence from your private treatment providers because they are familiar with your medical history, often over a long period of time.
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.
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.
Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization.
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This form may be submitted in person or mailed to the VA health care facility where care was provided. Addresses of VA health care facilities can be found at: .
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).
Use VA Form 21-0538 to verify the status of your dependents (spouse or children). We use this information to determine if youre eligible to continue receiving additional compensation based on how many dependents you have.

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