VA Form 10-5345 authorizes VA to release your health information to another person or organization. Use it when you want VA treatment records sent to an outside doctor, attorney or other recipient. If you want the copy delivered to you, the corresponding form is 10-5345a.

Download the current VA Form 10-5345 PDF

Download the official May 2026 VA Form 10-5345 PDF, linked from VA's form page. I checked both pages of that edition on October 2, 2026. Its fields are not numbered, so this walkthrough follows the printed labels in order.

The second page matters as much as the first. It separates permission for certain sensitive diagnoses from the general records request, asks when authorization expires, and requires a signature. An older example may show different consent language.

Who uses this form, and when?

Use 10-5345 when the destination is someone outside VA. For example, you may want VA to send treatment notes to an outside clinician reviewing your medical history for a claim. You identify the records, their recipient and the purpose of the release.

VA's Privacy Act guidance makes the distinction explicit: 10-5345a is a request for your own copy; 10-5345 is an authorization for disclosure to a third party. A recipient's willingness to help with your claim does not tell VA which records you have authorized it to send.

This form also differs from two other requests:

  • VA Form 20-10206: Requests military or benefits records held by VA, including your claims file, often called a C-file. That file and your health facility's treatment chart serve different purposes.
  • VA Forms 21-4142 and 21-4142a: Allow VA to obtain records from outside providers for a benefits claim. They concern records coming into VA, while 10-5345 authorizes health information going to an outside recipient.

For the latter forms, use VA's 21-4142 and 21-4142a instructions. Do not send 10-5345 expecting it to replace them.

Page 1: Identify the facility, patient and recipient

The following fields appear at the top of the current PDF.

To: Department of Veterans Affairs. Enter the name and location of the VA health care facility holding the records. Identify the medical center or health system where you received care. A benefits regional office is not the same office as the hospital's records department.

Last name, first name, middle name. Enter the patient's name in the order shown. This is the person whose health information will be released, even if someone else helps complete the form.

Date of birth. Use month/day/year. The May 2026 form identifies the patient through these fields; it does not contain a Social Security number field.

Patient's mailing address. Include the street address, city, state and ZIP code. Keep this separate from the recipient address below it.

Name and address of the organization or individual receiving the information. Identify exactly who should get the records. Use a complete delivery address and the appropriate office or individual. Confirm the destination with the recipient before signing; a business name without a usable address leaves the request unfinished.

Purpose or need. Select the applicable purpose: treatment, benefits, legal, employment or other. Explain an “other” purpose on the line provided. Choose the actual use, since the sensitive-diagnosis instructions on page 2 distinguish treatment from non-treatment purposes.

Page 1: Specify the records you authorize

The information-requested area lets you select multiple categories. Complete the details beside each selected category so the records office can tell what you mean.

  • Health summary: The printed scope is the prior two years. This selection alone does not request a lifetime treatment chart.
  • Patient medical records: Enter the dates for the records you want released.
  • Inpatient discharge summary: Give the relevant hospitalization dates.
  • Progress notes: Specify clinics with their date ranges, providers with their date ranges, or a date range for the notes requested.
  • Operative or clinical procedures: Identify the procedure and date.
  • Lab results: Identify particular tests and dates, or the requested date range.
  • Radiology reports: Name the examination and date. The label asks for reports; if the recipient needs the actual images, describe that separately and confirm the format with the office.
  • List of active medications: Specify the active medications requested as the form directs.
  • Vaccination: Provide the requested dose, lot number, date and location information to identify the record.
  • Administrative records: Specify which administrative records you want released.
  • Other: Describe material not adequately covered by the earlier selections.

For claim preparation, match the selection to the question the recipient needs to answer. If an outside clinician needs notes from a particular treatment period, identify that period. A broad request and a focused request are different choices; neither becomes complete merely because every box is checked.

Keep a separate list of records you still need. Claim Raven's Evidence Checklists lets you choose a condition-specific list, add notes and record your progress. You can note the facility, date range and request date beside the evidence task, then return when the records arrive.

Page 2: Review sensitive diagnoses and authorization

Repeat the patient's name and birth date at the top of page 2. Then read the sensitive-diagnosis section before making any selections.

For a non-treatment purpose, the form provides authorization boxes for information concerning drug abuse, alcoholism or alcohol abuse, sickle cell anemia, and HIV. Review the applicable categories when a release for benefits or another non-treatment purpose needs that information. These are disclosure choices, not a list of disabilities you are claiming.

For a treatment purpose, the May 2026 language says information on these diagnoses may be released even when those category boxes are unchecked. A separate box lets you decline release of sensitive diagnoses for treatment under this specific authorization. The form says that choice does not govern unrelated future requests.

The authorization paragraph explains that signing is voluntary. It also explains that information may be redisclosed after release and may no longer have the same federal confidentiality protection. Read that consequence alongside the recipient and scope you selected.

You may revoke authorization in writing, except for action already taken in reliance on it. The form says revocation becomes effective when received by the Release of Information unit at the facility holding the records. Revocation cannot retrieve information already sent.

Page 2: Choose expiration and sign

The expiration area asks you to select one of three alternatives:

  • After a one-time disclosure, if all needs are satisfied.
  • On a specified future date, different from the date you sign.
  • Under a condition you describe in the space provided.

Choose the option that reflects your request. A one-time release to a named recipient does not need an invented open-ended expiration date.

The patient signs in ink and enters the signing date. If a legal representative signs, the form provides separate signature and date lines, a printed-name field and a relationship-to-patient field. Confirm the representative's authority with the records office; helping type the form does not itself establish that authority.

Leave For VA Use Only blank. VA records the type and extent of information released, the release date and the staff member responsible.

Fictional example: Send treatment notes to an outside reviewer

This is a fictional worksheet exercise, not a real veteran, clinician or claim. It contains no personal identifiers to copy.

An unnamed veteran wants an outside clinician to review VA orthopedic treatment for a benefits-related medical evaluation. The requested period is January 1, 2024, through September 30, 2026.

  • Facility: The VA health system where those visits occurred.
  • Recipient: The outside clinician's verified name, office and delivery address.
  • Purpose: Benefits, because the stated purpose of this release is the benefits-related review.
  • Progress notes: Orthopedics, January 1, 2024, through September 30, 2026.
  • Radiology reports: The specific examination names and dates the clinician requested.
  • Sensitive diagnoses: Reviewed individually for this non-treatment release, rather than automatically selected or ignored.
  • Expiration: One-time disclosure, if that matches the complete request.
  • Signature: The patient's ink signature and actual signing date.

The requested period reaches beyond the prior two years, so checking only the health-summary box would not describe this request. The example authorizes existing records; it does not ask VA to write a new opinion or decide the disability claim.

Where to submit the signed form

Send it to the Release of Information office at the VA facility where you received care. VA's current privacy guidance lists in-person, mail, fax and My HealtheVet secure messaging routes for a third-party disclosure, with a signed authorization.

  • Online: Use My HealtheVet secure messaging to the appropriate Release of Information team and include the signed authorization. If that team is unavailable in your account, contact the facility for an alternative route.
  • Mail: Use that facility's Release of Information mailing address, including any listed mail stop. There is no single national mailing address printed on 10-5345.
  • Fax: Use the treating facility's published Release of Information fax number. The benefits compensation-intake fax is not a universal medical-records destination.
  • In person: Bring the completed form and valid identification to the facility's records office.

To find the actual mailing address and fax, open the facility through VA's location finder, select Other services, then Access your health records. VA's records-request instructions describe this path and advise outpatient-clinic patients to call first about where their records are held.

Check these details, then track the release

Before submitting, compare the patient information on both pages, the recipient address, dates requested, sensitive-information selections, expiration choice and signatures. Keep both pages and your submission confirmation together.

After submission, follow up with the records office if you need to clarify scope or delivery. Confirm that the intended recipient received the requested date range and record types. Delivery of records is separate from the recipient reviewing them or filing evidence in a claim.

A health record also does not establish every element of a claim by itself. VA's evidence guidance explains the different evidence questions. Records from military service, discussed in our service treatment records glossary, may answer different questions from later VA treatment notes.

Use 10-5345a for your own copy and 20-10206 for a claims-file request. Use 21-22 or 21-22a when appointing a representative; permission to receive health records is a separate function. If records will support a Supplemental Claim, our 20-0995 walkthrough explains that application.

Verified October 2, 2026: VA's form page, both pages of the May 2026 PDF, current Privacy Act guidance, facility-request instructions and linked Claim Raven tools. Local mailing addresses and fax numbers depend on the treating facility. The example demonstrates field choices only.

Where to go next

Claim Raven is data analysis, not legal, medical, or VA-accredited advice. Consult the VA records office about release requirements and an accredited representative about your claim.

-Landon Founder, Claim Raven | U.S. Army Veteran