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  1. www.va.gov › st-louis-health-care › medical-recordsMedical Records Office | VA St Louis Health Care | Veterans ...

    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)

  2. www.va.gov › vaforms › medicalVA Form 10-5345 - VA.gov Home | Veterans Affairs

    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.

  3. www.va.gov › resources › how-to-get-your-medicalHow to get your medical records from your VA health facility

    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.

  4. sa1s3.patientpop.com › assets › docsAUTHORIZATION FOR RELEASE OF MEDICAL RECORDS - PatientPop

    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: ______________________________

  5. www.wonder.legal › us › modeleMedical Records Request - FREE - Sample, Template - Wonder.Legal

    This Medical Records Request document is used by a Patient to request that a Healthcare Provider who has treated them release their medical records to a specific Recipient. Medical records contain sensitive and personal information and are considered protected and confidential.

  6. www.warrelatedillness.va.gov › WARRELATEDILLNESSVA Form 10-5345, Request for Consent to Release of Medical ...

    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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  8. www.clfamilymembers.fsc.va.gov › Home › DownloadFormREQUEST FOR AND AUTHORIZATION TO RELEASE MEDICAL

    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