Get 10 5345 R 663

The 10 5345 R 663 form is a request for and consent to release medical records from the Department of Veterans Affairs. Completing this form online allows users to efficiently manage their medical information requests.

Follow the steps to successfully complete the form.

1. Press the ‘Get Form’ button to obtain the form and open it in your browser.
2. Enter the patient's name and social security number in the designated fields if the patient data card imprint is not used.
3. Specify the organization or individual to whom the information is to be released by providing their name and address.
4. Indicate the request for information by checking the applicable boxes regarding the conditions such as drug abuse or alcoholism.
5. Detail the information requested by checking the appropriate box(es) and providing any specifics regarding the dates of the records needed.
6. State the purposes or needs for which the information will be used by checking the relevant boxes, ensuring clarity on the intended use.
7. Review the authorization statement to ensure accuracy, and then sign and date the form in the designated area.
8. Once the form is completed, you can choose to save the changes, download the form for your records, print it out, or share it as needed.

Take control of your medical records by filling out the 10 5345 R 663 form online today.