United States Department of Veterans Affairs

VA Eastern Kansas 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.

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 is expert in our patients' rights and their medical records.

The Release of Information Office can be found at:

Topeka: Leavenworth:
Building 1, room A104 Building T150
(785) 350-4407 (913) 682-2000 ext. 52360

How to Request Information

To request a medical record, please select one of the forms listed in the column to the right, complete the requested information, sign the form and include phone number under your signature.

If you are being seen at the Topeka VA or at one of our Community Bases Outreach Clinics in Abilene, Chanute, Emporia, Ft Scott, Garnett, Holton, Junction City, Lawrence, Russell, Salina, or Seneca you may mail or fax your request to: ;

VA Eastern Kansas Health Care System
Attn: Release of Information Office
2200 SW Gage Blvd
Topeka, KS 66622
Fax: (785) 350-4426

If you are being seen at the Leavenworth VA or at one of our Community Bases Outreach Clinics in St. Joseph or Wyandotte you may mail or fax your request to:

VA Eastern Kansas Health Care System
Attn: Release of Information Office
4104 S 4th Street
Leavenworth, KS 66048
Fax: (913) 758-4103

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.


Patient Information

Patient Information
Eligibility
Make, Change, or Cancel an Appointment
Advance Directives
Patient Education
Customer Service
Discharge
Billing and Insurance
Release of Information
Non-VA Care
Beneficiary Travel

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