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

Louisville VA Medical Center

Release of Information

Our Release of Information staff will be happy to assist you with requests for copies of your medical record. We can also Image of Paperwork help when you need forms completed by your provider.

We can assist you with the following —

  • access to your medical records
  • obtaining copies of private medical records when needed by your provider
  • requests to amend your medical records
  • transferring your records to or from another VA facility
  • in-person-authentication for access to MyHealtheVet

The staff in Release of Information are experts in patients' rights concerning their medical record.

The Release of Information Office can be contacted at (502) 287-5719 and is located in the Medical Center on Zorn Avenue, 2nd Floor, Room  B-230.

How to Request Information

To request copies or access to your medical record, please print and fill out one of the forms listed in the column to the right, complete the requested information, sign and date the form, then mail it to us at the following address —

VA Medical Center
Release of Information (136D)
800 Zorn Avenue
Louisville, KY 40206

All forms must contain an original signature.  We cannot accept copies, faxed requests, or e-mailed forms.

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

If you are unable to retrieve these forms electronically, they may also be obtained from the Release of Information Office. 


Information for Patients

Information for Patients
Eligibility
Make, Change, or Cancel an Appointment
DAV Transportation
Advance Directives
Patient Education
Reporting Safety or Quality Care Issues
Customer Service
Discharge
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 Individual's Request for Medical Records from MyHealtheVet (VA 10-5345a-MHV)
pdf document Individuals' Request for a Copy of Their Own Health Information (VA 10-5345a)

You must have the free Adobe Reader to open the PDF documents listed on this page.  Visit the VA Viewer Software  page to download the latest viewers.

Related Links

Notice of Privacy Practices

My HealthEVet