VA Form 10-5345A Printable, Fillable in PDF

Table of Contents

VA Form 10-5345A Printable, Fillable in PDF – Individuals’ Request for a Copy of Their Own Health Information (VA Form 10-5345A) is a document produced by the United States Department of Veterans Affairs (Veterans Affairs) (VA). Veterans mostly use this form to seek a copy of their VA health records, which are kept on file by the Department of Veterans Affairs. The most recent version of the form was made available to the public on June 1, 2017. An up-to-date fillable version of the VA Form 10-5345A is available for download below, or it may be accessed on the VA’s website by visiting their website.

All veterans have the right to get a copy of their medical records, incident reports, and hazardous exposure report, which are retained by the Department of Veterans Affairs. When completing the form, you have the option of requesting that your records be sent to you exclusively. You must submit the VA 10-5345, Request for and Authorization to Release Medical Records or Health Information, to be eligible for the medical data distribution to a third party benefit. When the veteran submits the VA Form 10-5345A, the information sought may be utilized to support the veteran’s claim for disability compensation or to determine his or her level of impairment.

Instructions for completing VA Form 10-5345A

A veteran fills out the VA Form 10-5345A, which is available online. The following are the steps to be taken:

Please complete this paper with all of the information asked. Failure to provide the requested information, or the supply of erroneous information, may result in the VA being unable to complete the request.
The failure to submit correct and exact information in this document has no impact on any other benefits to which the veteran may be entitled.
The veteran must sign the paper with his or her hand.
Alternatively, if the veteran is unable to sign the document, their legal agent may do so on their behalf. The representative will be required to specify the authority, such as guardianship or power of attorney.
Requests sent by e-mail will not be accepted;
You may be charged a price for photocopying your medical data. Any other form of charge is not permissible under any circumstances.

Detailed Instructions for Completing VA Form 10-5345A

It is simple to complete the VA Form 10-5345A since the majority of its fields are self-explanatory:

Enter the name and location of the VA Health Care Facility where you were treated, as well as the address of the facility where the document is currently being filed, to get the medical information.
Please include your entire name, including the middle initial, in your message.
You must enter the last four digits of your Social Security number;
To get started, enter your date of birth. Make certain that all of the information is accurate.
The section “Description of Information Requested” has a list of checkboxes that must be completed. By checking the appropriate option, you may specify the information you’re looking for.
Select the delivery method that you desire.
Date the form, print it, and then sign it by hand.

Where Should VA Form 10-5345A Be Sent?

You have two options for submitting VA Form 10-5345A to the Release of Information personnel at the relevant VA Medical Center: either mail or fax.

via the mail;
a face-to-face meeting

The paper should be sent or delivered to the address listed in Box 1 of this document. By visiting the Department of Veterans Affairs website, you may find the specific location of the VA Healthcare Facility. If you were treated at more than one VA Health Care Facility and require medical records from each of them, you will need to submit a separate request to each of the facilities.