VA Form 10-5345 | How to Fill & Submit (PDF)

Like every other cadre of persons, the veterans too, are prone to illnesses that call for sound medical interventions. These interventions are recorded and kept for future reference. The access to these records is however restricted in scope. It is only allowed pursuant to the use and filling of the VA Form 10-5345 which forms the basis of our discussions hereunder.


For a start, the VA Form 10-5345 stands for the ‘Veterans Affairs Request for and Authorization to Release Medical Records or Health Information.’ It is basically a document that plays the role of requesting permission to collect and access the treatment records of veterans.

This happens when they are no longer in active duty and only if they have ever, in their course of active duty, received treatments at any of the veterans’ healthcare facilities.


Follow-up on Treatments

The number 1 use of this form is to follow up on the treatment. A doctor or any other healthcare practitioner might want to know how a patient he handled in the past is currently doing. The same might also be necessary if a new doctor has come in.

Future References

In some instances, it might usually be necessary that the past medical records be scrutinized. With regards to this, the forms serve as the basis of any future references. They are the ones that are relied on to be able to make any serious decisions thereafter.

Monitoring of Progress

Lastly, any healthcare facility and practitioner will definitely want to track and monitor the progress of their past clients. This is a feat they can only achieve if they have unbridled access to these sensitive medical records.



Doctors who have treated the veteran in any healthcare facility that is dedicated to the veterans anywhere are mandated and allowed to use this form. They do so to extract information about their past patients and ascertain their progress.

Healthcare Providers

Other healthcare providers like nurses, surgeons, and social workers who may have handled the patient at some point, or another also qualify to use this form. They too may have to refer to the patient’s past and how he is presently responding to the treatments.


Step I: Download the form

Before you may even think of filling it, you have to download it. Visit the relevant government portal to be able to do so. Then, read the privacy act as it spells out the ethos you have to adhere to while utilizing the form.

Veterans Affairs (VA Form 10-5345)

Step II: Enter your patient information

Next, enter your patient information. These include:

  • Name and address of the veteran’s affairs care facility
  • Last and first names along with the middle initial
  • Your Social Security Number
  • Address and name of the organization
  • Individual titles (if any) who will access the information upon release

Step III: Express your intention to access the medical records

At this stage, express your intention to access the medical records. Cover the following two areas or scopes:

a.) Veteran’s Request

  • Read the information contained in the box
  • Inspect and date the boxes that apply

b.) Information Requested

  • Yet again, check those boxes that apply in this section
  • Provide the dates that each cover
  • Lay down the exact purposes for which the information shall be used by the person who requests the release of the same. Do this in the field that is provided for.

Step IV: Authorization

  • This is the place where you officially give up access rights. You have to read this section carefully before filling the vacant spaces provided for.
  • A small field exists in the paragraph. In this field, enter the extra pieces of information which may be necessary. Then, you have to fix the date information as well. 
  • Lastly, a larger field also exists. In this one, you enter all the relevant pieces of information that may be needful. Be detailed while at it.

Step V: Append your signature

  • Lastly, append your signature to the document to make it official. Before doing this, you have to review all the ‘Practitioner’s Opinions and Statements’ section for clarity and proof.
  • Then, date the signature in the mm/dd/yyyy format. Do so in the date box provided.
  • Furnish the signature of the person who is authorized to sign on behalf of the patient. While at it, attach the ‘Power of Attorney (POA)’ in case the same is required.
  • The remaining portion of this document is for official use of Veteran’s Administration only.


Well, we are now confident that you can go ahead to download and fill the form. As you may already have realized, this is not so daunting a task. You only have to pay keen attention to the fields and parameters set forth. All the best in your subsequent use of the form.

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