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Va Form 10-5345: What You Should Know

For further information, visit Health Care Finance Administration's “Federal Websites” page — or call a local phone VA Form 10-5345 — Seattle.gov 10-5345. VA FORM. JUN 2017. Page 2 of 2. LAST 4 SSN PRIVACY ACT INFORMATION: This form requires the following information to be sent or otherwise provided by you to the Department of Veterans' Affairs: Acknowledgement of receipt  of the Notice of Privacy Act Disclosures (Notice) that is attached hereto and located at the bottom of this form.  Notice Information Notice Number No.  Notice Date 11-16-16 6-10-17 6-10-17 5-3-19 11-30-17  VARIANTS OR OTHER INFORMATION THAT MAY BE RELEASED Use EXISTING STOCK OF VA FORM 10-5345, DATED NOV 2004. OMB Number: 2. Estimated Burden: 1 minute. Privacy Act and Paperwork Reduction Act. See  below  Health Insurance Portability and Accountability Act of 1996: Information that requires access under the Federal Health Insurance Protocol Access to Health Information. Portability and Accountability Act of 1998 (Pub. L. 104-199), 45 U.S.C. CHAPTER 37B: INFORMATION TO BE RELEASED. Use EXISTING STOCK OF VA FORM 10-5345, DATED NOV 2004. OMB Number: 2. Estimated Burden: 1 minute. Privacy Act and Paperwork Reduction Act.  See  below. Section 1081.50(b) of the Internal Revenue Code: See below. Access the U.S. Office of Management and Budget's “Federal Websites” (or call a local phone number) or call the Veterans Information Hotline on -1 if you have questions about accessing information for the Veterans' Affairs.  Health Information Portability and Accountability Act of 1996: Information that requires access under the Federal Health Insurance Protocol Access to Health Information. Use EXISTING STOCK OF VA FORM 10-5345, DATED NOV 2004.

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FAQ - Va Form 10-5345

What is a VA Form 10 5345?
A Veterans Affairs Request for and Authorization to Release Medical Records or Health Information, or VA Form 10-5345 , is a document that will allow the collection of treatment records for doctors or any health care provider, once their active duty is completed if they have ever been treated at any Veteran's Facility ...
Where do I mail Form 10 5345?
Where to Send VA Form 10-5345? The completed and signed VA 10-5345 should be sent to the specific VA health care facility where the veteran was treated.
What is a VA 10 form?
For Veterans to apply for enrollment in the VA health care system. The information provided on this form will be used by VA to determine your eligibility for medical benefits and on average will take 30 minutes to complete.
Where do I send my VA authorization form?
1nDepartment of Veterans Affairs.n2nEvidence Intake Center.n3nPO Box 4444.n4nJanesville, WI 53547-4444.n5nVA gov. www.va.gov.n6nDirect Upload via access.va.gov.n
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