United States Department of Veterans Affairs
United States Department of Veterans Affairs

Memphis VA Medical Center

Release of Information

Our Release of Information staff will be happy to assist you with requests for your medical records.

We can assist you with the following —

  • access to your medical records
  • obtaining copies of your medical records
  • requests to amend your medical records

The Release of Information Office is located in the Ambulatory Care building, Ground floor, room 6008.

How to Request Information

To request a medical record, please download one of the forms listed in the column to the right, complete the requested information, sign the form, and mail it to the following address —

VA Medical Center
Business Office
Release of Information (136F)
1030 Jefferson Avenue
Memphis, TN 38104

Because forms must contain an original signature, e-mailed forms cannot be accepted.

Requests for records will take approximately 10-14 days to process.

Fees

Photocopying fees may be assessed.


Information for Patients

Information for Patients
Eligibility
Make, Change, or Cancel an Appointment
Hoptel
Advance Directives
Patient Health Education
Reporting Safety or Quality Care Issues
Customer Service
Discharge
Billing and Insurance
Release of Information

Release of Information Forms

pdf format Request for and Authorization to Release Medical Records or Health Information (VA 10-5345)
pdf format Individuals' Request for a Copy of Their Own Health Information (VA 10-5345a)

Related Links

Notice of Privacy Practices