|
- VA Form 10-5345 - 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 Your disclosure of the information requested on this form is voluntary
- VA Form 10-5345, Request for Consent to Release of Medical Records . . .
We expect that the time expended by all individuals completing this form will average 2 minutes This includes the time to read instructions, gather the necessary facts and fill out the form The purpose of this form is to specifically outline the circumstances under which we may disclose data
- Step-by-Step Guide to Filling Out VA Form 10-5345
VA 10-5345 helps veterans control who sees their medical records It is simple but must be filled out carefully You can use this form for personal, legal, or medical reasons Just follow the steps in this guide Always keep a copy and track your request If you need help, contact your VA center directly This guide should help make the process
- Attachment 2-VA Inquiry Systems and Service Record Links
HVRP staff downloads the VA Form 10-5345 Request For and Authorization to Release Health Information located at https: www va gov find-forms about-form-10-5345 This form is an online fillable PDF or can be printed and completed The veteran must complete the VA Form 10-5345
- VA Form 10-5345 - co. liberty. tx. us
VA may also use this information to identify Veterans and person claiming or receiving VA benefits and their records, and for other purposes authorized or required by law
- VA Form 10-5345 - Washington
We anticipate that the time expended by all individuals who must complete this form will average 2 minutes This includes the time it will take to read the instructions, gather the necessary facts and fill out this form The execution of this form does not authorize the release of information other than that specifically described below
- About VA Form 10-5345 - Veterans Affairs
Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization Securely view, download, and share your medical records
- Free VA Form 10-5345 | PDF - eSign
VA Form 10-5345 is a medical records release form used to request the release of a veteran’s health information held by the Department of Veteran Affairs to a non-VA entity
|
|
|