Medical records office | va northern arizona health care | veterans affairs
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Per VHA Directives, we have 20 business days to process all requests. Requests are accepted in-person, through My HealtheVet, mail, and fax. Please contact the facility to verify if
submission by email is available. HOW WE SHARE YOUR RECORDS WITH PROVIDERS OUTSIDE VA The Veterans Health Information Exchange (VHIE) program lets us electronically share your health
information with health care providers who treat you, including participating non-VA providers if you receive care outside of VA. This program is voluntary, and you can choose not to share
your information (opt out of sharing). Learn more about VHIE TO OPT OUT OF SHARING Fill out, sign, and date VA Form 10-10164 (Opt Out of Sharing Protected Health Information). Mail the
signed, completed form to our ROI office. You can also bring it with you or ask for this form when you visit us. Download VA Form 10-10164 (PDF) NOTE: If you had revoked your permission to
share, before September 30, 2019, your opt out status will stay active. You don’t need to submit form 10-10164. TO ALLOW SHARING AFTER OPTING OUT If you change your mind and want to share
your health information, you’ll need to submit VA Form 10-10163 (Request for and Permission to Participate in Sharing Protected Health Information). Mail the signed, completed form to our
ROI office. You can also bring it with you or ask for this form when you visit us. Download VA Form 10-10163 (PDF)