How to Fill a VA Form 10-5345 | 7-Steps Guide

VA-Form 10-5345 or the ‘Veterans Affairs Request for and Authorization Release Medical Records or Health Information is a document issued by the Department of Veterans Affairs (VA) for the collection of treatment records for health care providers or doctors after their active duty is completed if they have been treated at any Veteran Facility anywhere.

According to the Health Insurance Portability and Accountability Act, the VA Form 10-5345 is used to obtain a veteran’s written and signed authorization to help process the release of their medical records.

Free Forms

Free Downloadable Authorization to Release Medical Record Form as Pdf format
Free Downloadable Authorization to Release Health Information Form as Pdf format

    Instructions for VA Form 10-5345

    For the form to be considered valid and aid in the processing of the release of your medical information, the following requirements must be fulfilled:

    • The document must contain complete, accurate, and verifiable information
    • The VA – Department of Veterans Affairs may not be able to process the request for the release/disclosure of medical information if the last four digits of your Social Security Number and Date of Birth are not provided
    • Only a written request to recall the authorization should be made as verbal revocations may not be accepted
    • After you have completed and signed the form, make sure to retain a copy of the form and keep it in a safe place for references
    • Requests for the release/disclosure of medical records should be made by your legal representative if you are unable to do so

    Two forms are related to VA Form 10-5345:

    • VA Form 10-5345a: Also referred to as the Individual’s Request for a Copy of Their Own Health Information is a document issued by the US Department of Veterans Affairs (VA) and used to request a copy of a veteran’s health records maintained by the VA.
    • VA Form 10-5345a-MHV: Also referred to as Individual’s Request for Medical Record from My HealtheVet or MHV, Individual’s Request for a Copy of Their Own Health Information is a document issued by the VA and used by Veterans to request a copy of their medical data through My HealtheVet account.

    How to Fill a VA Form

    The form usually comprised two pages, with most fields being self-explanatory. However, it is essential to understand how to fill each section appropriately to avoid filling the form repeatedly.

    Here is a comprehensive step-by-step breakdown on how to fill the form:

    Step 1: Download the VA form 10-5345

    The first step is downloading the VA Form 10-5345 and going through the Privacy Act and Paper Reduction section. It is crucial to go through the Privacy Act to understand how the information you provide will be used and how it can be disclosed, and by whom.

    Step 2: Patient information

    Under the patient’s information section in the form, make sure to provide the following information:

    • The address and name of the VA care facility
    • Your full name, i.e., first, last, and maiden name
    • Your Social Security Number
    • The address and name of the organization or individual to whom the medical information is to be released to

    Step 3: Veteran’s request

    Go through this section keenly and check and update all the applicable boxes. Make sure to provide the requested information.

    Also, make sure to:

    • Check all applicable boxes in this section of the form
    • Provide the dates covered by each
    • Specify why you are requesting the release/disclosure of your medical records and how the receiving party shall use the information

    Step 4: Information requested

    Make sure to specify the information you want to be disclosed to the requesting party and check all the appropriate boxes and provide details on the date range and nature of the information to be disclosed. This will help your request for the release of medical information to be processed much faster.

    Step 5: Sensitive diagnosis

    Under the Sensitive Diagnosis section, make sure to specify if the medical data to be released is for non-treatment purposes. It is vital to understand that this information will be disclosed for treatment purposes without your consent if not specified. If you would like for this information not to be released, make sure to check the box that states your refusal to release this information without your consent.

    Step 6: Authorization

    Be cautious when you read the authorization statement. If additional information is required, provide all of the required data along with the date when the information is entered. Also, select the authorization expiration date or conditions in the ‘expiration’ section.

    Step 7: Signature

    After providing all the information, go through the document keenly to ensure that all the information is well captured and review the practitioner’s opinions and statements section.

    After signing the document, include the date of signing, provide the party’s signature authorized to sign for the patient, and attach a power of attorney if required.

    When requesting the release/disclosure of a veteran’s medical records from a veteran’s health care facility after their active duty is completed, you should use a form. The form will provide all the identifying information required to process the medical records release and provide the health care facility with a reason the release of such documents should be processed.

    The VA form can also be completed and submitted to the VA offices if one needs to disclose their medical data to any individual or organization for employment, treatment, legal, or other related purposes. Regardless of the reason for completing the VA form, it is crucial to ensure that all the information is complete, accurate, and verifiable.

    Frequently Asked Questions

    Where should the VA Form 10-5345 be sent?

    After completion, the VA form 10-5345 should be sent to the specific VA health care facility where the Veteran was treated. If the Veteran was treated in different facilities, then a separate VA form 10-5345 should be sent out to each VA health care facility.

    About This Article

    Melissa Horton
    Authored by:
    Legal Writing | M.A Marketing, B.A. Finance
    Melissa Horton is a highly skilled legal writer and co-owner of a leading financial planning firm in Washington, D.C. With over a decade of experience in the financial services and planning industry, Melissa's expertise lies in teaching clients how to maintain sustainable financial health. She holds a JD degree and possesses a deep understanding of legal principles and regulations, enabling her to deliver exceptional legal writing that is both informative and accessible. Melissa's passion for helping individuals navigate complex legal matters shines through in her work, making her a trusted authority in the field of legal writing.

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