Va 10-5345 dec Form 2021-2024

Va 10-5345 dec 2021-2024 Form: What You Should Know

This is a request only. Information released under this request must not be considered confidential if it is part of an investigation or an adjudication of violations concerning the law, rules, or regulations of the Department of Veterans Affairs or the Service. Information that is subject to release under this request that is protected by the Privacy Act and the Privacy Act or other applicable law is not disclosed by VA under this request. VA Form 10-5345 can be obtained by calling and selecting option 2 for assistance. Please remember that this form must be completed, signed and mailed to VA, so that VA can forward it upon completion of the request form.  Any other offering of information, including, but not limited to, a facsimile, is not eligible to be part of the information request under this form. This form will be used to authorize VA to make a routine disclosure under the Health Insurance. Portability and Accountability Act,  Part 160 and Part 164 of the Health Insurance Portability and Accountability Act (HIPPO) of 1996 and other Federal law. VA Form 10-5345 is used to authorize us to release information about a veteran. Please provide any relevant documentation (e.g., medical records, treatment request form, etc.), if available. VA Form 10-5345a — VA Medical Release Please make a copy of this request form and a copy of any applicable documentation (e.g.,  medical records, treatment request form, etc.), with the information you wish to release. There are no documents found. I am requesting a copy of any medical records from your office. This request will only be considered by your office. The VA health information system must only be used, or released if required for one of the purposes identified under this request. Please  address all other requests to the following address: Records Management Division 1090 O'Connor Drive West Sacramento, CA 95829 The form must be completed and signed. If signing with your computer signature, please use your name instead of your VFW address. For additional information or to view a copy of Form 10-5345; go to: Veterans Affairs You may also contact the Privacy Office for help submitting the request for electronic filing. A link can be found below.

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