VA Form 10-5345: Request for & Authorization to Release Info

VA Form 10-5345: Request for & Authorization to Release Info – VA Form 10-5345: Request for and Authorization to Release Health Information is a key document for U.S. veterans and their representatives. It authorizes the Department of Veterans Affairs (VA) to share protected health information with third parties outside the VA system.

What Is VA Form 10-5345?

VA Form 10-5345, titled “Request for and Authorization to Release Health Information,” allows veterans to permit the VA to disclose their medical records or health information to non-VA individuals or organizations, such as private doctors, hospitals, attorneys, employers, or insurance providers.

This form complies with the Health Insurance Portability and Accountability Act (HIPAA) and VA privacy regulations under Title 38 U.S.C. It differs from VA Form 10-5345a, which veterans use to request copies of their own records.

Current revision: May 2026 (fillable PDF available).

Why Veterans Need VA Form 10-5345?

Veterans often require this form for:

  • Coordinating care with private healthcare providers
  • Supporting disability claims or legal proceedings
  • Employment or insurance requirements
  • Benefits applications involving non-VA parties

The form ensures controlled, authorized release of sensitive information while protecting veteran privacy.

How to Download VA Form 10-5345?

Official Download:
Download VA Form 10-5345 Fillable PDF (from VA.gov)

Always use the official VA website for the most current version.

Step-by-Step Guide: How to Fill Out VA Form 10-5345?

Filling out the form is straightforward but requires accuracy to avoid delays.

  1. VA Facility Information: Enter the name and location of the specific VA health care facility holding the records.
  2. Patient Information: Provide full name, date of birth, mailing address, and other identifiers.
  3. Recipient Information: Specify the name and full address of the individual or organization receiving the information.
  4. Purpose of Release: Check applicable boxes (Treatment, Benefits, Legal, Employment, Other) and describe if needed.
  5. Information Requested: Select specific record types, such as:
    • Health Summary (Prior 2 Years)
    • Patient Medical Records (with dates)
    • Inpatient Discharge Summary
    • Progress Notes
    • Lab Results, Radiology Reports, Medications, etc.
    • Specify dates or details for precision.
  6. Sensitive Diagnoses (Page 2): For non-treatment purposes, decide on release of information related to drug abuse, alcoholism, sickle cell anemia, or HIV. There is an option to restrict sensitive info even for treatment in this specific authorization.
  7. Expiration and Authorization: Choose when the authorization expires (one-time, specific date, or condition). Sign and date (wet signature required). Legal representatives must note their relationship.

Submit the completed form to the Release of Information (ROI) office at the relevant VA facility by mail, fax, or in person.

  • Disclosure is voluntary, but incomplete information may prevent processing.
  • The VA cannot condition treatment or benefits on signing this form (with limited exceptions for research).
  • Authorizations can be revoked in writing at any time.
  • Released information may not retain federal protections once disclosed.

Always review the Privacy Act Statement on the form.

Common Mistakes to Avoid

  • Using the wrong form (10-5345 vs. 10-5345a)
  • Incomplete recipient details
  • Vague record descriptions (be specific with dates/types)
  • Missing signatures or dates
  • Forgetting to specify sensitive information preferences

Double-check everything before submission.

Where to Submit VA Form 10-5345?

Send or deliver the form to the medical records/ROI office at the VA facility where care was received. Processing times vary—contact the facility for status. Some veterans use My HealtheVet for related services.

Additional Resources for Veterans

  • Official VA Form Page: VA Form 10-5345 on VA.gov
  • How to Get Your VA Medical Records: VA official guidance
  • VA Health Care Locations: Find your facility

For questions, contact your local VA medical center or call VA benefits support.

Note: This article provides general information based on official VA sources as of 2026. Forms and procedures can update—verify details directly on VA.gov for your situation. Consult a VA-accredited representative or legal professional for personalized advice.