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VA Ann Arbor Healthcare System

 

Request Your Medical Records

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, etc.

The Release of Information Office is located on the first level of the main hospital building within the Eligibility Department in room C111-1E 1st floor clinical addition.

How to Request Information

To request a medical record, please print one of the forms listed in the column to the right, VA Form 10-5345a, if you are requesting information to be sent directly to you; VA Form 10-5345 you are requesting information to be sent to a third party, (i.e., attorney, insurance company, doctor's office, etc.). Complete the requested information, sign the form, and mail it to the following address -

VA Ann Arbor Healthcare System
Release of Information (HIMS) -- H-136
2215 Fuller Road
Ann Arbor, Michigan 48105

Requests for records will take approximately 10-14 days to process.

Fees

There is no cost to send copies directly to another healthcare provider. A patient may be provided with one free copy of his/her medical record.

Additional one sided copies are $0.15 per page.