Get Va 10-5345 2023-2026

The VA 10-5345 form is essential for requesting and authorizing the release of health information from the Department of Veterans Affairs. This guide provides you with clear, step-by-step instructions on how to complete the form online effectively.

Follow the steps to fill out the VA 10-5345 online.

1. Click the ‘Get Form’ button to obtain the VA 10-5345 form and open it for online filling.
2. Enter the 'date of birth' in the specified format (mm/dd/yyyy) at the top of the form.
3. Provide your 'last name,' 'first name,' and 'middle name' clearly as it appears on official documents.
4. Fill in your 'patient's mailing address,' ensuring you include the complete address with city, state, and zip code.
5. Specify the 'name and address of the organization, individual, or title of individual' to whom the information will be released.
6. Indicate the 'purpose(s) or need' for the requested information by checking the relevant boxes such as treatment, benefits, legal, employment, or other; providing a brief description if necessary.
7. Select the type of information you are requesting by checking applicable box(es) such as health summary, patient medical records, or any specific categories you need.
8. For sensitive diagnoses, review the section and indicate your preferences regarding the release of this information for non-treatment purposes.
9. Complete the 'authorization' section by certifying that the request is made voluntarily and that you understand the implications.
10. Select the expiration of the authorization, specifying one-time disclosure, a future date, or conditions under which it expires.
11. Sign the form in the 'patient signature' section, and if applicable, have a legal representative sign and fill in their details.
12. Finally, save changes to the completed form, and you can choose to download, print, or share it as needed.

Complete your VA 10-5345 form online today for an efficient process in releasing your health information.