VA Form 10-252: Authorization to Release Health Info (PDF) – Veterans enrolled in VA health care often need to manage how their medical information, particularly immunization records, is shared with state and local public health departments. VA Form 10-252 is a specific authorization form designed for this purpose. It allows the VA to report your vaccination data to help support community public health efforts while complying with HIPAA and other privacy laws.
What Is VA Form 10-252?
VA Form 10-252 is officially titled “Authorization to Release Protected Health Information to State/Local Public Health Authorities.” The current version dates to around 2020 (with possible updates). It is a one-page form that specifically authorizes the release of immunization records from your VA electronic health record to state and local public health authorities.
This form is distinct from the more general VA Form 10-5345 (used for broader health information releases to third parties). It focuses narrowly on immunizations for public health reporting purposes.
Why Veterans Should Consider Signing VA Form 10-252?
Public health authorities rely on complete immunization data to track vaccination rates, respond to outbreaks, ensure compliance with school or workplace requirements, and protect community health. By signing this form:
- VA can share your immunization records (including future vaccinations) when the state requests reporting.
- It supports accurate public health surveillance without requiring repeated individual authorizations.
- Your VA treatment, payment, enrollment, or benefits eligibility cannot be conditioned on signing the form.
The authorization is voluntary, and the form explicitly states that VA will not withhold care or benefits if you choose not to sign.
Key Details Covered by the Form
- Patient Information: Full name, birth date, and last four digits of SSN (used to locate records).
- Recipient: State and Local Public Health Authorities.
- Information Released: Immunization records from the VA electronic health record, including those created after signing.
- Duration: Effective for 10 years from the signature date, unless revoked earlier.
- Revocation: You can revoke the authorization in writing at any time (effective upon receipt by the VA Release of Information Unit). However, actions already taken cannot be undone.
Important Privacy Note: Once released, the information may be redisclosed by the receiving public health authorities and may no longer have the same federal protections.
How to Fill Out and Submit VA Form 10-252?
- Download the Form: Get the official PDF directly from the VA.
Download VA Form 10-252 (PDF) - Print or fill digitally where possible. Provide accurate personal details.
- Read the privacy statement and authorization language carefully.
- Sign and date the form.
- Submit to your local VA health care facility’s Release of Information (ROI) office, typically by mail, fax, or in person. Contact your VA facility for specific submission instructions.
You can also manage many health records through your My HealtheVet or VA.gov account, but this specific authorization usually requires the paper form.
Benefits of Allowing Immunization Data Sharing
- Helps maintain up-to-date state immunization registries (IIS).
- Supports public health initiatives, outbreak tracking, and eligibility for certain programs.
- Reduces administrative burden for Veterans who need official records for schools, travel, employment, or other needs.
- Contributes to broader community health efforts, including responses to diseases like flu, COVID-19, and others.
Frequently Asked Questions About VA Form 10-252
Is signing mandatory?
No. It is completely voluntary. VA cannot deny you care or benefits if you decline.
Can I revoke it later?
Yes, in writing. Contact your VA facility’s ROI office for guidance.
Does this affect my overall medical record privacy?
No — it is limited to immunization records for public health purposes only.
Who should sign?
The patient (or authorized representative with proper documentation).
For the most current guidance, always refer to official VA resources or consult your local VA health care facility.
Stay Informed and Protected
Understanding forms like VA Form 10-252 empowers Veterans to make informed decisions about their health information. Whether you choose to authorize sharing or not, staying proactive with your VA health records is essential.
Official Download Link:
Download VA Form 10-252 Here
For additional VA forms and resources, visit VA.gov Forms. Always verify details with your local VA facility, as processes can vary slightly by location. This article is for informational purposes and is based on official VA sources.