How to Fill Out and Submit VA Form 10-5345: Filling, Filing, Revoking

VA Form 10-5345 is the written authorization you sign to let the Department of Veterans Affairs release your health records to someone outside the VA, whether that’s a private physician, an attorney, an insurance company, or a claims representative. The form fits on a single page and can be downloaded from VA.gov or picked up at any VA medical center’s Release of Information office.¹ Filling it out correctly is mostly a matter of being specific: which facility, which recipient, which records, and for how long.

Make Sure You Have the Right Form

Form 10-5345 authorizes the VA to send your records to a third party. If instead you want a copy of your own records sent to you, the correct form is VA Form 10-5345a, which is built for personal copy requests and offers delivery options like paper, CD-ROM, or in-person pickup.² Using the wrong one won’t necessarily get you denied, but it will slow things down while staff figure out what you actually want.

Filling Out the Form Section by Section

Patient Identification

Enter your full legal name (last, first, middle), mailing address, and date of birth. The current October 2023 revision does not ask for a Social Security Number.¹ Match your name and date of birth to what the VA has on file for your health care enrollment. A nickname or a recently changed name that hasn’t been updated in the system can cause the request to bounce back.

VA Health Care Facility

Write the name and location of the VA facility where you received the care whose records you want released. This tells the VA which Release of Information office should handle the request. If you were treated at a Community Based Outpatient Clinic, call the medical records office first, because your file may actually live at the parent VA medical center.³

Recipient Information

Give the full legal name and complete mailing address of whoever is receiving the records. If it’s an organization, use the organization’s official name rather than just a contact person. Anything ambiguous gives the Privacy Officer a reason to pause the release.

Purpose of Disclosure

Check one of the pre-printed purposes: Treatment, Legal, Employment, or Benefits. If none fits, select “Other” and write a short description.¹ The purpose matters because it can affect what the VA is willing to send, particularly where sensitive diagnoses are involved. Provider-to-provider sharing under “Treatment” carries broader authorization under federal law than “Legal” or “Benefits.”

Which Records to Release

Instead of dumping your entire file, the form lets you check specific categories:

Health Summary (prior two years)
List of active medications
Radiology reports (specify exam name and date)
Lab results
Operative or clinical procedures (specify name and date)
Progress notes
Inpatient discharge summary
Vaccination records (dose, lot number, date, and location)
Other (write-in)

Be specific with dates. Checking “Lab Results” with no date range can return years of routine bloodwork, or prompt staff to call you for clarification and add days to the process.¹

Sensitive Diagnoses

Federal law gives extra protection to records involving four conditions: drug abuse, alcohol abuse, sickle cell anemia, and HIV.⁴ Under 38 U.S.C. § 7332, the VA will not include any records related to these conditions unless you separately and explicitly authorize release. The form has a dedicated Sensitive Diagnoses section with a checkbox for each condition. If you leave a box unchecked, those records are redacted from the release even if they otherwise fall within the date range and record types you asked for.

For any non-treatment purpose, you must affirmatively check each relevant box or those records stay sealed.¹

Expiration Date

Every authorization needs an end date, and the form asks you to enter one. There’s no default; you choose. A common approach is 90 days or one year out, depending on how long you expect the recipient to need updated records.¹ Too far out and the authorization stays live longer than you may want; too short and it can lapse before staff finish processing.

Signature

Sign in ink and date the form. If a legal representative signs for you, there are separate fields for the representative’s printed name, signature, and relationship to you. The Release of Information office may ask the representative to show documentation of legal authority, such as a power of attorney or guardianship order, so have that ready.¹

How to Submit the Completed Form

Send the form to the Release of Information office at the VA facility you named on it. Three options are available:

Mail or fax. Look up your facility at va.gov/find-locations, open its page, and under “Other services” select “Access your health records” for the correct address and fax number.³
In person. Hand-deliver the signed form to the medical records office during business hours.
Secure message. Some facilities accept requests through the secure messaging system on VA.gov. Send a message to a care team with “Release of Information” in the name at the facility where you received care. The VA acknowledges the message within three business days. Not every facility offers this; if you don’t see a matching team, use one of the other channels.³

Sending the form to the wrong facility is one of the most common delays. If your records live at a VA medical center in one city but you send the form to a nearby outpatient clinic, the request has to be rerouted before anyone starts working on it.

How Long Processing Takes

Timelines depend on how the records are stored. Electronic records may take up to 30 calendar days. Paper records, generally anything created before 1998, can take up to 60 calendar days.³ Some facilities post shorter targets, with several VA medical centers citing up to 20 business days. Requests that span many years or multiple clinics tend to run longer. Before anything goes out, a Privacy Officer reviews the package to confirm the disclosure matches what you authorized.

Revoking the Authorization

You can cancel a 10-5345 authorization at any time by sending a written revocation to the Release of Information office at the facility holding your records. It takes effect as soon as that office receives it, but it cannot undo any disclosures already made.¹ If the office mailed your records last week, revoking today won’t pull them back. That is another reason to set a reasonable expiration date on the original form.

If the Veteran Has Died

Form 10-5345 is for a living veteran authorizing release of their own records. If you are the next of kin of a deceased veteran, the process is different and runs through the National Archives rather than the standard VA release form. The National Archives defines next of kin as the unremarried widow or widower, son, daughter, father, mother, brother, or sister of the deceased. You’ll need proof of death (a death certificate, a letter from the funeral home, or a published obituary) and a signed, dated request submitted by mail or fax using NA Form 13042. If restricted categories like substance abuse or HIV treatment are involved, NA Form 13036 may also be required. Third parties acting for the next of kin need a signed and dated authorization from the next of kin, and those authorizations expire one year from the date signed.⁵

1
Department of Veterans Affairs. VA Form 10-5345 – Request for and Authorization to Release Health Information
2
Department of Veterans Affairs. VA Form 10-5345a – Individuals’ Request for a Copy of Their Own Health Information
3
Veterans Affairs. How to Get Your Medical Records From Your VA Health Facility
4
Office of the Law Revision Counsel. 38 USC 7332 – Confidentiality of Certain Medical Records
5
National Archives. Access to Clinical and Medical Treatment Records by the Veteran, Next-of-Kin, or Person of Record