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Jun 3, 2024 · Get your records by mail or fax. 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. Download VA Form 10-5345a (PDF)
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Aug 19, 2022 · How to submit a medical records request. You’ll need to fill out an Individuals’ Request for a Copy of Their Own Health Information (VA Form 10-5345a). Get VA Form 10-5345a to download. Submit your completed form to your VA health facility’s medical records office.
The form authorizes release of information in accordance with the Health Insurance Portability and Accountability Act, 45 CFR Parts 160 and 164; 5 U.S.C. 552a; and 38 U.S.C. 5701 and 7332 that you specify.
Use this form to provide your written authorization to obtain your treatment records, so the VA can get the information required to process your claim. For more information, you can contact us online through Ask VA: https://ask.va.gov/ or call us toll-free at 1-800-827-1000 (TTY: 711).
TO REQUEST RELEASE OF MEDICAL INFORMATION PLEASE COMPLETE AND SIGN THIS FORM. I, ____________________________________hereby voluntarily authorize the disclosure of information from my health record. (Name of Patient) Patient Information: Patient Name: __________________________________________Record Number: ______________________________
Department of Veterans Affairs. REQUEST FOR AND CONSENT TO RELEASE OF MEDICAL RECORDS PROTECTED BY 36 U.S.C. 7332. The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Act.
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REQUEST FOR AND AUTHORIZATION TO RELEASE MEDICAL RECORDS OR HEALTH INFORMATION. NOTE: ADDITIONAL ITEMS OF INFORMATION DESIRED MAY BE LISTED ON THE BACK OF THIS FORM. AUTHORIZATION: I certify that this request has been made freely, voluntarily and without coercion and that the information given above is