VA Form 10-5345: Request for and Authorization to Release Protected Health Information
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JustFill is not affiliated with U.S. Department of Veterans Affairs (VA). This is an independent third-party tool to help you complete VA Form 10-5345. Always download the current blank form from the official source and verify your completed copy before signing or submitting. Official VA Form 10-5345 from U.S. Department of Veterans Affairs (VA)
VA Form 10-5345, Request for and Authorization to Release Protected Health Information, lets a Veteran (or their authorized representative) tell the VA to release specific medical records to a named person or organization. You list the records, dates, and who may receive them, then sign and date the authorization. With JustFill you upload the blank VA 10-5345 PDF, the AI detects each field, and you complete and download it free before submitting it to your VA facility.
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VA Form 10-5345 is the VA's medical-records release authorization. It directs a VA health facility to disclose your protected health information (PHI) — such as treatment records, lab results, or imaging — to a person or organization you name, for the purpose and time period you specify. It is governed by HIPAA and the Privacy Act, so it must be specific and signed. JustFill is a free way to complete the 10-5345 online without printing, so the names, dates, and record types are legible and the authorization is not rejected.
The official VA Form 10-5345 PDF is free to download from VA.gov and is in the public domain. Print it to bring or mail to your VA facility, or open the blank PDF in JustFill to type your answers on screen, then download the completed authorization free.
Get the official VA Form 10-5345 PDF from U.S. Department of Veterans Affairs (VA)What each section of VA Form 10-5345 asks for. JustFill’s AI will detect these fields automatically when you upload the PDF — review the breakdown below so you know what to enter.
Full name, date of birth, and Social Security or VA file number so the facility can locate your records.
The specific records and date ranges you authorize — be precise (e.g. "primary care notes, Jan 2023-present").
Name and address of the person or organization receiving the information.
Why the records are being released (continued care, legal, personal use, etc.).
A date or event when the authorization ends. If left blank, the VA applies its default.
Signed by the Veteran or authorized representative; an unsigned form cannot be honored.
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By uploading, you confirm you have the legal right to use this document.
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Official source: VA Form 10-5345 on U.S. Department of Veterans Affairs (VA)’s website
JustFill is an independent product and is not affiliated with, endorsed by, or sponsored by U.S. Department of Veterans Affairs (VA) or any government agency. Always verify your completed form on the official version before signing or submitting.