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About VA Form 10-5345 | Veterans Affairs
- https://www.va.gov/find-forms/about-form-10-5345/
- Get VA Form 10-5345, Request for and Authorization to Release Health Information. Use this VA form to authorize VA to share your health information with a third-party individual or organization. About VA Form 10-5345 | Veterans Affairs
REQUEST FOR AND AUTHORIZATION TO …
- https://www.va.gov/vaforms/medical/pdf/VA_Form_10-5345_%20Fillable.pdf
- 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 …
About VA Form 21-4142 | Veterans Affairs
- https://www.va.gov/find-forms/about-form-21-4142/
- Get VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA). Use this form to give VA permission to obtain your …
REQUEST FOR AND AUTHORIZATION TO …
- https://www.va.gov/files/2021-11/roi.pdf
- VA FORM . 10-5345 DEC 2017. Page 1 of 2 LAST NAME- FIRST NAME- MIDDLE INITIAL. LAST 4 SSN. PRIVACY ACT INFORMATION: The execution of this form does not …
AUTHORIZATION TO DISCLOSE INFORMATION …
- https://www.vba.va.gov/pubs/forms/VBA-21-4142-ARE.pdf
- 38, United States Code, allows us to ask for this information. You can provide this authorization by signing VA Form 21-4142. Federal law permits sources with information …
Medical Records Office | VA Black Hills Health Care
- https://www.va.gov/black-hills-health-care/medical-records-office/
- We can help you get copies of your VA medical records. We can also help you update your records. Call or visit one of our release of information offices. What to …
Medical Records / Release of Information - Veterans Affairs
- https://www.va.gov/central-ohio-health-care/medical-records-office/
- Medical Records / Release of Information Office First Floor, Room 1A180 Map of Central Ohio campus Phone: 614-388-7399 Hours: M-F, 8:00 a.m. to 3:30 p.m. …
Medical Records Office | VA Richmond Health Care
- https://www.va.gov/richmond-health-care/medical-records-office/
- 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 …
Veterans Affairs Request for and …
- https://eforms.com/release/va/
- Updated June 03, 2022. A Veterans Affairs Request for and Authorization to Release Medical Records or Health Information, or “VA Form 10-5345”, is a …
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