Va form 10 0454-2025

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Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization.
If you owe the VA call the Debt Management Center and make a Waiver Request. Fill out the forms, accurately state your financial status. And await their decision. The VA Debt Management Center will work with a Veteran to avoid the same experiencing a critical hardship financially.
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.
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 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.
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People also ask

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.

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