United States Department of Veterans Affairs

Salem 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 Buiding 2A, Room 124. Staff can be reached at (540) 982-2463, extension 2757.

How to Request Information

To request a medical record, please 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
Release of Information (136E5)
1970 Roanoke Blvd.
Salem, VA 24153

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

Requests for records will take up to 20 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

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