VA Form 10-0527: Release PHI to Choice/PC3 Program

VA Form 10-0527: Release PHI to Choice/PC3 Program – Veterans seeking timely community care through VA programs often need to share medical records with non-VA providers. VA Form 10-0527 streamlines this process by authorizing the release of protected health information (PHI) specifically for the Choice/PC3 Program.

What Is VA Form 10-0527?

VA Form 10-0527 is an official Department of Veterans Affairs document titled “Request and Authorization to Release Protected Health Information to the Choice/PC3 Program.” It allows VA health facilities and contractors to release relevant medical information to non-VA providers participating in the Choice or Patient-Centered Community Care (PC3) networks.

This HIPAA-compliant form ensures secure sharing of health records for treatment purposes when veterans receive care outside the VA system. The form was last revised in June 2015 and remains available on the official VA forms page.

Purpose of VA Form 10-0527

The primary purpose of this form is to facilitate seamless care coordination between VA and community providers in the Choice/PC3 Program. It authorizes the release of pertinent health information from a veteran’s VA health record for a specific referral or appointment.

Key features include:

  • Authorization for diagnosis and treatment information, including sensitive conditions protected under 38 U.S.C. § 7332 (such as sickle cell anemia, drug/alcohol abuse, or HIV).
  • Coverage for current and future diagnoses.
  • Validity for two years from the signature date, with the option to revoke in writing at any time.

This supports veterans who qualify for community care when VA facilities face long wait times, geographic challenges, or lack specific services.

Who Should Use VA Form 10-0527?

Eligible veterans enrolled in VA health care who are referred to non-VA providers through the Choice/PC3 Program (now part of the broader VA Community Care Network) should complete this form. It is particularly useful for:

  • Veterans needing specialist care not available at their local VA facility.
  • Those facing extended wait times or travel burdens.
  • Patients transitioning to community providers for authorized services.

Note: The Choice Program has evolved under the MISSION Act into the VA Community Care Network (CCN), but Form 10-0527 remains the specific authorization tool for legacy or related PC3 processes.

How to Fill Out VA Form 10-0527?

Filling out the one-page form is straightforward:

  1. Provide your full name (first, middle, last), birth date, and last four digits of your SSN.
  2. Include the requestor name if applicable.
  3. The form pre-specifies the information requested: “Pertinent health information from the health record for my referral or appointment.”
  4. Read the authorization language carefully, which covers protected conditions and the two-year duration.
  5. Sign and date the form.

The form includes clear Privacy Act information explaining voluntary disclosure and limitations.

Download the fillable PDF here: VA Form 10-0527 (PDF) Download Here

Submit the completed form to your VA health care facility’s Release of Information Unit or as directed by your VA provider.

Key Benefits of Using This Form

  • Faster Community Care Access: Enables non-VA providers to receive necessary records quickly for informed treatment.
  • HIPAA Compliance: Protects veteran privacy while allowing authorized sharing.
  • Broad Coverage: Includes sensitive health information with explicit consent.
  • Revocable: Veterans maintain control and can revoke authorization as needed.

For general health information release to other third parties, veterans may use VA Form 10-5345. For enrolling in VA health care, complete VA Form 10-10EZ.

Learn more about current VA Community Care eligibility and processes on the official VA website: VA Community Care.

Frequently Asked Questions About VA Form 10-0527

Is the form still current?
Yes, it is the designated form for Choice/PC3 authorizations and is hosted on va.gov.

Can I revoke the authorization?
Yes, in writing to the Release of Information Unit at your VA facility. Revocation is effective upon receipt, except for actions already taken.

What if I need records for a different purpose?
Use VA Form 10-5345 for broader releases. Consult your VA provider or facility for guidance.

Where do I submit the form?
Follow instructions from your referring VA provider or submit to the ROI office at your VA health care facility.

Veterans are encouraged to contact their local VA facility or use the VA’s community care resources for personalized assistance with referrals and authorizations.

This article is for informational purposes only and is based on official VA sources. Always verify the latest requirements directly with the Department of Veterans Affairs.