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OPT-OUT OF SHARING PROTECTED HEALTH INFORMATION THROUGH HEALTH INFORMATION EXCHANGES By completing this form, you are requesting to be opted out of health information exchanges (HIE) for treatment

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How to fill out va form 10 10164

01

To fill out VA form 10-10164, follow these steps:

02

Start by entering your personal information in Section I. This includes your name, Social Security number, and contact information.

03

In Section II, provide details about your military service. This includes the branch of service, dates of service, and rank at discharge.

04

In Section III, you will need to provide information about your medical conditions. List any and all conditions that you believe are related to your military service.

05

Section IV requires information about any treatment you have received for these medical conditions. This includes the name of the provider, dates of treatment, and a brief description of the treatment.

06

If applicable, provide information about any medications you are currently taking for your medical conditions in Section V.

07

Section VI is for providing information about any other medical evidence you have to support your claim. This can include medical records, statements from healthcare providers, or any other relevant documentation.

08

Finally, review the entire form to ensure all information is accurate and complete. Sign and date the form in Section VII.

09

Please note that this is only a general guide. It is recommended to read the instructions provided with the form for any specific requirements or additional information.

Who needs va form 10 10164?

01

VA Form 10-10164 is needed by veterans who are filing a claim for disability compensation related to their military service. This form is used to provide detailed information about the veteran's medical conditions and any treatment or evidence supporting their claim. It is necessary for veterans who wish to apply for disability benefits through the Department of Veterans Affairs (VA).

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