United States Department of Veterans Affairs

Alexandria VA Health Care 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 as well as the clinic clerks.

We can assist you with the following —

  • access to your medical records
  • obtaining copies of your medical records
  • completion of forms for benefits, insurance, and other reasonsare referred to your provider by our staff or clinic clerks.

The Release of Information Staff has expertknowledge in our patients' rights and their medical records.

The Release of Information Office is located on the first floor in building 7, room 113.

How to Request Information

To request a medical record, please use 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 —

Alexandria VA Health Care System
Health Information Management
Release of Information
P.O. Box 69004
Alexandria, LA 71306-9004

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

Fees

There is no cost to send copies directly to another health care provider. If copies are for a patient's personal use, the first copy is free. Fees will be assessed for all additional copies.


Patient Information

Patient Information
Eligibility
Make, Change, or Cancel an Appointment 
Advance Directives 
Patient Education
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) 

Related Links

Notice of Privacy Practices