Get the free VA Form 10-5345 - VA.gov
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AUTHORIZATION TO RELEASE MEDICAL Recorder Patient, Parent or Guardian:
We will be happy to forward a copy of the medical record(s) you have requested. The requested medical records
will be forwarded
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How to fill out va form 10-5345
How to fill out va form 10-5345
01
To fill out VA Form 10-5345:
02
Start by downloading the VA Form 10-5345 from the official VA website or obtain a physical copy from your nearest VA facility.
03
Read the instructions on the form carefully to understand the information you need to provide.
04
Begin filling out the form by entering your personal information, such as your name, address, and contact details.
05
Provide your relevant military service information, including your branch of service, dates of service, and service number.
06
Indicate the specific VA medical records you are requesting by checking the appropriate boxes.
07
If you require any auxiliary aids or services to access the requested medical records, make sure to indicate your needs.
08
Sign and date the form to certify the accuracy of the information provided.
09
Submit the completed VA Form 10-5345 to the designated VA office or facility through mail, in person, or via online submission if available.
Who needs va form 10-5345?
01
VA Form 10-5345 is needed by veterans or individuals who are requesting their own medical records from the Department of Veterans Affairs (VA). It is also used by authorized individuals, such as family members or representatives, who are requesting the medical records of veterans.
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What is va form 10-5345?
VA Form 10-5345 is the Authorization for Release of Medical Records Information form.
Who is required to file va form 10-5345?
Veterans or their authorized representatives are required to file VA Form 10-5345.
How to fill out va form 10-5345?
To fill out VA Form 10-5345, you need to provide personal information, specify the purpose of release, and sign the form.
What is the purpose of va form 10-5345?
The purpose of VA Form 10-5345 is to authorize the release of medical records information to specified individuals or organizations.
What information must be reported on va form 10-5345?
VA Form 10-5345 requires information such as name, date of birth, SSN, contact information, and details of medical records to be released.
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