Va form 10 0485-2025

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The document is a request and authorization form for the release of protected health information (PHI) to the Nationwide Health Information Network (NwHIN) under HIPAA regulations. It outlines the voluntary nature of the disclosure, specifies that it pertains to treatment purposes only, and includes details about the types of health information being released, such as diagnoses related to Sickle Cell Anemia and substance abuse. The authorization remains valid for five years and can be revoked at any time. It emphasizes that failure to provide requested information may hinder processing but will not affect other benefits.

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Click ‘Get Form’ to open VA Form 10-0485 in the editor.
Begin by entering the Patient Full Name. Fill in the Last, First, and Middle name fields accurately.
Provide the last four digits of your Social Security Number (SSN) in the designated field to ensure proper record identification.
Next, enter the Requestor Name. This should be the individual requesting the release of information.
In the 'Information Requested' section, specify the pertinent health information you wish to be released from your electronic health record.
Review and confirm that all information is accurate before signing. Your signature certifies that this request is made voluntarily and without coercion.
Finally, date your form to complete it. Ensure all sections are filled out correctly before submitting.

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Versions	Form popularity	Fillable & printable
2020	4.4 Satisfied (26 Votes)
2020	4.8 Satisfied (129 Votes)
2019	4.8 Satisfied (67 Votes)
2019	4.8 Satisfied (91 Votes)
2018	4.8 Satisfied (55 Votes)
2015	4.3 Satisfied (104 Votes)
2014	4.8 Satisfied (63 Votes)
2012	4.8 Satisfied (160 Votes)
2011	4.8 Satisfied (99 Votes)
2011	4.8 Satisfied (81 Votes)
2000	4.8 Satisfied (187 Votes)
1995	4.8 Satisfied (57 Votes)

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What is VA form 10 5345 used for?

Who needs VA 10-2850c? The VA Form 10-2850c is required for healthcare professionals applying for employment at the Veterans Affairs health facilities. It is needed by individuals seeking to establish qualifications for specific healthcare positions.

Do I need a VA form 10 2850c?

Use VA Form 10-10EZ if youre a Veteran and want to apply for VA health care. You must be enrolled in VA health care to get care at VA health facilities or to have us cover your care at a community care provider (an approved non-VA provider).

What is the VA form for total and permanent disability?

Use VA Form 21-526EZ when you want to apply for VA disability compensation (pay) and related benefits.

Where do I send my VA form 10 5345a?

2:45 4:21 You must fill out 5345. Form for each location.MoreYou must fill out 5345. Form for each location.

What is the VA form for release of medical records?

To request a copy of your VA medical records by mail or fax, send a signed and completed VA Form 10-5345a to our Release of Information office. Per VHA Directives, we have 20 business days to process all requests. Requests are accepted in-person, through My HealtheVet, mail, and fax.

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.

Va form 10 0485-2025

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What is VA form 10 5345 used for?

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What is the VA form for release of medical records?

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Va form 10 0485-2025

Here's how it works

How to use or fill out VA Form 10-0485 with our platform

See more va form 10 0485 versions

Complete this form in 5 minutes or less

Got questions?

What is VA form 10 5345 used for?

Do I need a VA form 10 2850c?

What is the VA form for total and permanent disability?

Where do I send my VA form 10 5345a?

What is the VA form for release of medical records?

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People also ask

What is a VA medical release form 10 5345?

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