VA Form 10-0485 Request for and Authorization to Release Protected Health Information to Health Information Exchanges

VA Form 10-0485 Request for and Authorization to Release Protected Health Information to Health Information Exchanges

What Is VA Form 10-0485?

This is a legal form that was released by the U.S. Department of Veterans Affairs on December 1, 2016 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is VA Form 10-0485?
A: VA Form 10-0485 is a form used to request and authorize the release of protected health information to health information exchanges.

Q: What is the purpose of VA Form 10-0485?
A: The purpose of VA Form 10-0485 is to allow individuals to give permission for their health information to be shared with health information exchanges.

Q: Who can use VA Form 10-0485?
A: Any individual who receives healthcare services from the Department of Veterans Affairs (VA) can use VA Form 10-0485 to authorize the release of their protected health information.

Q: What is protected health information?
A: Protected health information refers to any information about a person's health, healthcare services received, or payment for healthcare services that can be linked to that individual.

Q: What are health information exchanges?
A: Health information exchanges are networks that allow healthcare providers to securely share and access patient health information electronically.

Q: Why would someone need to release their protected health information to a health information exchange?
A: Releasing protected health information to a health information exchange can improve the coordination and quality of healthcare services, especially when seeing multiple healthcare providers.

Q: Can someone revoke their authorization to release protected health information?
A: Yes, an individual can revoke their authorization to release protected health information at any time by completing a Revocation of Authorization form.

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Form Details:

  • Released on December 1, 2016;
  • The latest available edition released by the U.S. Department of Veterans Affairs;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;

Download a fillable version of VA Form 10-0485 by clicking the link below or browse more documents and templates provided by the U.S. Department of Veterans Affairs.

Download VA Form 10-0485 Request for and Authorization to Release Protected Health Information to Health Information Exchanges

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  • VA Form 10-0485 Request for and Authorization to Release Protected Health Information to Health Information Exchanges, Page 1
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