Get Va 10-5345 2020-2026

The VA 10-5345 form is essential for authorizing the release of health information by the Department of Veterans Affairs. This guide provides clear, step-by-step instructions to help users easily complete the form online.

Follow the steps to successfully complete the VA 10-5345 form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing the name and address of the VA health care facility where the information will be sent. This ensures that the request reaches the correct department.
3. Enter the date of birth in the specified format (mm/dd/yyyy). This information is necessary for accurate record identification.
4. Fill in the patient’s last name, first name, and middle name in the appropriate fields.
5. Complete the mailing address section, including city, state, and zip code. Correct contact information is vital for future communications.
6. Specify the person or organization to which the health information will be released. Provide their name and address as needed.
7. Indicate the purpose of the information request by checking one or more boxes for treatment, benefits, legal, employment, or other specified needs.
8. Detail the information requested by checking the applicable boxes. You can specify additional requirements for health summaries, progress notes, or laboratory results here.
9. If requesting information about sensitive diagnoses, review this section carefully and check the appropriate boxes as needed.
10. Complete the authorization section by certifying that the request is made voluntarily. Ensure that all provided information is accurate.
11. Select the expiration condition for the authorization to clarify how long the consent will be valid.
12. Finally, sign and date the form in the designated spaces. This step finalizes your request.
13. After completing the form, you can save changes, download, print, or share the completed VA 10-5345 as needed.

Complete your VA 10-5345 form online today for a seamless experience.