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VA Form 10-5345A Individuals' Request for a Copy of Their Own Health Information
What Is VA Form 10-5345A?
VA Form 10-5345A, Individuals' Request for a Copy of Their Own Health Information is a document issued by the U.S. Department of Veterans Affairs (VA) . This form is mainly used by veterans to request a copy of their health records maintained by the VA.
Alternate Name:
- VA Release Form 10-5345A
The latest version of the form was released on June 1, 2017 . An up-to-date fillable version of the VA Form 10-5345A is available for download below or can be found on the VA website.
All veterans have the right to claim their medical records, incident reports, and toxic exposure report, kept by the VA. When completing the form you may request the delivery of your records to yourself only. To claim the medical data delivery to a third party you need to submit the VA 10-5345, Request for and Authorization to Release Medical Records or Health Information. The information requested via the VA 10-5345a may be used by the veteran to support the application for disability benefits, or to establish impairment rating.
VA Form 10-5345A Instructions
The VA 10-5345A is filled out by a veteran. The instructions are as follows:
- Provide all the information requested in this document. Failure to furnish the data or provision of inaccurate data may result in VA inability to process the request;
- Failure to provide accurate and precise data in this paper has no effect on other benefits the veteran may be entitled to;
- The veteran must hand sign the document;
- If the veteran is not able to sign the paper, it can be signed by their legal representative. If this is the case, the representative will have to indicate the authority, e.g. guardianship or power of attorney;
- E-mailed requests are not accepted;
- You may be charged a photocopying fee for your medical records. Any other type of fee is not permitted.
How to Fill Out VA Form 10-5345A?
The VA 10-5345A is easy to complete, since most of its fields are self-explanatory:
- Enter the name and address of the VA Health Care Facility where you were treated and where the document is now submitted to in order to request the medical data;
- Indicate your full name including middle initial;
- Enter four last digits of your Social Security number;
- Enter your date of birth. Make sure all the information is correct.
- The section "Description of Information Requested" contains a list of checkboxes. Specify the information you request by ticking the corresponding box.
- Pick your preferred delivery method.
- Date, print the form and hand sign it.
Where to Send VA Form 10-5345A?
You may submit VA Form 10-5345A to the Release of Information staff situated in the corresponding VA Medical Center in two ways:
- by mail;
- in person.
The document should be sent or brought to the address indicated in Box 1. You can check up the exact address of the VA Healthcare Facility online at the VA website. In case you were treated in several VA Health Care Facilities and need to obtain medical records from all of them, you will have to send a separate request to each facility.
