VA Form 10-5345a-mhv Individuals' Request for a Copy of Their Own Health Information

What Is VA Form 10-5345A-MHV?

VA Form 10-5345A-MHV, Individuals' Request for a Copy of Their Own Health Information (or the Individual's Request for Med Record from My HealtheVet) is a document issued by the Department of Veterans Affairs (VA) and used by veterans to request a copy of their medical data through My HealtheVet account. An up-to-date fillable version of the VA Form 10-5345a-MHV is available for digital filling and download below or can be found on the VA forms website.

The latest version of the form was released by the VA in May 2012 and has two related forms: VA Form 10-5345 (Request for and Authorization to Release Medical Records or Health Information) and the VA Form 10-5345A (Individuals' Request for a Copy of Their Own Health Information).

My HealtheVet is a secure online service that contains Personal Health Records (PHR) of veterans. It allows veterans to access their PHR: health education information, personal health journals, and other electronic services. Some accounts may even view their DoD Military Service Information. To use the service, the veteran has to pass the authentication first. The VA release form 10-5345a-MHV is also applied in the process of veteran's authentication in My HealtheVet and to upgrade the corresponding My HealtheVet account to Premium.

The VA has strict security policies and protects all personal health data uploaded to the website. However, once you download it from My HealtheVet, you become responsible for keeping it safe and private.

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Download VA Form 10-5345a-mhv Individuals' Request for a Copy of Their Own Health Information

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VA Form 10-5345A-MHV Instructions

The form includes two pages. The first page is a form the veteran needs to complete. The second contains the information about My HealtheVet, authentication, and VA health record. Moreover, there is data about the privacy and security of health records, as well as the privacy rights of a veteran.

The VA Form 10-5345A-MHV instructions are as follows:

  • You are not required to complete this document unless it displays a valid OMB number.
  • You need to provide all the requested information - including your Social Security number - completely and accurately. Failure to provide the data may result in VA inability to comply with the request.
  • If you are unable to sign the request, it can be signed by your legal representative. In this case, it is required to indicate the authority, e.g. power of attorney or guardianship.

How to Fill out VA Form 10-5345A-MHV?

The VA Form 10-5345A-MHV is self-explanatory and easy to complete. However, if you experience any difficulties, you may schedule an appointment with a My HealtheVet representative in any local VA healthcare facility. The authorized representative will make sure you have viewed the My HealtheVet Orientation Video, provide you with the VA 10 5345A-MHV necessary to complete, answer the questions if any, confirm the document is filled out correctly and the request is succeeded.

You have to enter all the information requested in the document. For the form to be valid and the VA could start the processing it must be signed and dated properly. You are required to indicate the date in MM/DD/YYYY format.

Where to Send VA Form 10-5345A-MHV?

You are required to submit VA Form 10-5345A-MHV completed and signed to the Release of Information Office. These offices are located in all the VA medical facilities. The address of the closest facility can be found online at the VA official website. When submitting a completed form in person, you will need to bring an ID.

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