The following information about this VA form comes from the VA forms database, and any changes are updated here nightly. Contact the form administration for further information.
Link to form
https://www.va.gov/vaforms/medical/pdf/10-252 Authorization To Release Protecte…
Form number
10-252
Row ID
10592
Form title
AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION TO STATE/LOCAL PUBLIC HEALTH AUTHORITIES
Issue date
Revision date
Form administration
VHA
Number of pages
1
Deleted
False
Form name
Authorization to Release Protected Health Information to State/Local Public Health Authorities
Form Language
English
Related to
Benefits
VA health care
VA records
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