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

VAMC Mountain Home, Tennessee

Release of Information

Our Release of Information staff will be happy to assist you with requests for your medical records. Form completion can be expedited by taking them directly to your provider at your next scheduled appointment.

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 Staff is experts in patients' rights and their medical records.

The Release of Information Office is located in the Building 204, Ground floor, room L012.

How to Request Information

To request a medical record, complete 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 (136D1)
PO Box 4000
Mountain Home, TN 37684

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

Requests for records may take up to 20 business 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.


Information for Patients

Information for Patients
Eligibility
Make, Change, or Cancel an Appointment
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 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