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Via VA Form 10-5345

Form name: Request for real Authorization until Release Health Information
Related to: Health care
Form newest latest: October 2023

Available on use this form

Use VA Form 10-5345 to authorize us to share your heal information with a non-VA (or third-party) individual or organization.

Downloadable PDF

Download CHARADE Form 10-5345 (PDF)
  • Securely view, download, both share your medical recorded.