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  • Va Form 10 0493

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Authorization for Use & Release of Individually Identifiable Health Information for Veterans Health Administration (VHA) Research Subject Name (Last, First, Middle Initial): Subject SSN (last.

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A VA Form 21-0845 is known as an Authorization to Disclose Personal Information to a Third Party. This form should be submitted by someone who wishes to have the Department of Veterans Affairs release their personal information to a third party. This information could be about your beneficiaries or about your claims.

"I am a VA employee who is authorized to receive or request evidentiary information or statements that may result in a change in your VA benefits. The primary purpose for gathering this information or statement is to make an eligibility determination.

DEPARTMENT OF VETERANS AFFAIRS (VA) Use this form to provide your written authorization to obtain your treatment records, so the VA can get the information required to process your claim.

Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.

Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization.

Use VA Form 21-0845 to authorize VA to share your personal information with a non-VA (third-party) individual or organization.

Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization.

VA Form 21, APPLICATION FOR ACCREDITATION AS SERVICE ORGANIZATION REPRESENTATIVE.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232