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About VA Form 10-5345 | Veterans Affairs
- https://www.va.gov/find-forms/about-form-10-5345/
- Home Find a VA form About VA Form 10-5345 About VA Form 10-5345 Form name: Request for and Authorization to Release Health Information Related to: …
REQUEST FOR AND AUTHORIZATION TO …
- https://www.va.gov/vaforms/medical/pdf/VA_Form_10-5345_%20Fillable.pdf
- "routine use" disclosure of the information as outlined in the Privacy Act system of records notices identified as 24VA10A7 "Patient Medical Record - VA", 08VA05 "Employee …
About VA Form 21-4142 | Veterans Affairs
- https://www.va.gov/find-forms/about-form-21-4142/
- 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 …
REQUEST FOR AND AUTHORIZATION TO …
- https://www.va.gov/files/2021-11/roi.pdf
- request and authorize Department of Veterans Affairs to release the information specified below to the organization, or individual named on this request. I understand that the …
VA Form 21-4142 - Veterans Benefits Administration …
- https://www.vba.va.gov/pubs/forms/VBA-21-4142-ARE.pdf
- section iv - records to be released to the department of veterans affairs (va) section iii - information regarding source of record(s) section ii - patient identification for records va …
Veterans Affairs Request for and …
- https://eforms.com/release/va/
- Veterans Affairs Request for and Authorization to Release Medical Records or Health Information (VA Form 10-5345) Updated June 03, 2022. A Veterans Affairs …
Find A VA Form | Veterans Affairs
- https://www.va.gov/find-forms/
- Find out how to change your address and other contact information in your VA.gov profile for disability compensation, claims and appeals, VA health care, and other …
VA Form 10-5345, Request for Consent to Release …
- https://www.warrelatedillness.va.gov/WARRELATEDILLNESS/docs/HealthCare_Provider_ROI_FORM.pdf
- The execution of this form does not authorize the release of information other than that specifically described below. The information requested on this form is solicited under …
Medical Records Office | VA San Diego Health Care
- https://www.va.gov/san-diego-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 …
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