Get Va 10-5345 2021-2025

Filling out the VA 10-5345 form is an important step in managing your health information and ensuring that it is released to the appropriate parties. This guide provides comprehensive, step-by-step instructions to help you accurately complete the form online.

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

1. Press the ‘Get Form’ button to access the VA 10-5345 form and open it in the online editor.
2. In the section labeled 'To', fill in the name and location of the VA Health Care Facility where you are requesting information.
3. Provide your date of birth in the format mm/dd/yyyy.
4. Enter your last name, first name, and middle name in the designated fields.
5. Complete your mailing address, including city, state, and zip code.
6. Specify the name and address of the organization or individual to whom the information should be released.
7. Indicate the purpose or need for the information by checking the applicable box(es), such as treatment, benefits, legal, employment, or other. If 'other', please specify.
8. In the 'Information requested' section, check all applicable boxes and provide the extent or nature of the information. This may include health summaries, medical records, progress notes, lab results, etc.
9. If applicable, review the 'Sensitive Diagnoses' section and indicate if you do not want sensitive information released by checking the appropriate box.
10. Complete the authorization section by certifying that your request is made voluntarily and that the provided information is accurate to the best of your knowledge.
11. Select the expiration conditions for the authorization, such as after a one-time disclosure, on a specified date, or under certain conditions.
12. Sign and date the form in the designated fields. If a legal representative is involved, they should sign and provide their information as well.
13. Once you have completed the form, you can save your changes, download the form, print it, or share it as needed.

Take a moment to complete your VA 10-5345 form online today to ensure your health information is managed efficiently.