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

Bay Pines VA Healthcare System

Release of Information

Our Release of Information staff will be happy to assist you with requests for your medical records. We also assist providers with completing forms for patients.

We can assist you with the following:

  • access to your medical records
  • obtaining copies of your medical records
  • requests to amend your medical records
  • completion of forms for benefits, insurance, and other reasons

The Release of Information Staff are the experts in our patients' rights and their medical records.

How to Request Information

To request a medical record, please print 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 —

Bay Pines VA Healthcare System
Business Office Service
Release of Information (16A1)
PO Box 5005
Bay Pines, FL 33744

The Release of Information Office is located in the main hospital building, first floor, room 1E 303. You can also contact ROI by calling (727)398-6661 or 1-888-820-0230* and press #6.

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

There is no cost to send copies directly to another health care provider. If copies are for a patient's personal use, photocopying fees may be assessed.


Access to Records through MyHealthevet

If you want full access to your medical records through www.MyHealth.va.gov, you need to come to the Release of Information Office so that we can complete an in-person verification.


Patient Information

Patient Information
Eligibility
Make, Change, or Cancel an Appointment
Advance Directives
Patient Education
Customer Service
Things to Know
Discharge Procedures
Billing and Insurance
Release of Information

Release of Information Forms

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

Related Links

pdf document Notice of Privacy Practices
You must have the Adobe Reader to open the forms listed above. Download the latest free Adobe Reader.
* The toll free number may only be used from outside Pinellas County, but within the state of Florida.