United States Department of Veterans Affairs

Northport VA Medical Center

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 is located in Building 200, Room B1-7F. Call 631-261-4400 x2631.

How to Request Information

To request a medical record, please select one of the forms from the right column, enter the requested information, sign the form and mail it to the following address:

VA Medical Center Northport
79 Middleville Road
Release of Information
Building 200, Room B1-7F
Northport, New York 11768

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.


Northport VA Medical Center
Patient Information

Patient Information
Patient Handbook
Eligibility
Make, Change or Cancel an Appointment
Advance Directives
Patient Education/Library
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