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

VA Palo Alto Health Care System

Release of Information

Employee handing form and clipboard to patient

  We can assist you with:

  ▪  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



How to Request Information (by Mail)

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 —

VA Palo Alto Health Care System
Release of Information (11MR)
3801 Miranda Ave
Palo Alto, CA 94304

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

 

Forms

Instructions that will assist you in filling out the forms: 

 

PDF (VA 10-5345)
Request for Medical Record

----------------------------

PDF (SF 180)
Request for Military Record

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PDF (VA 10-3203)
Authorization for use of Picture and/or Voice

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PDF (VA 10-5345a)
My Health eVet Request Form

 
How to Request Information (Walk-Ins)
 
Facility Open   Location Extension*
Palo Alto Mon-Fri
8 AM - 4:30 PM
  Building 100
  First Floor
  Room A1-302
  & A1-304
X66406
or x67298
Menlo Park Tues & Thurs
8 AM - 4:30 PM
  Building 334
  Second Floor
  Room A3-304
x22899
Livermore Mon-Fri
8 AM - 4:30 PM
  Trailer 34
  Room 106
x35217
San Jose Mon, Weds, & Fri
8 AM - 4:30 PM
  Main Building
  Room A304
x73554

*First dial the main number (650) 493-5000.   Then enter the extension when prompted.