United States Department of Veterans Affairs
James J. Peters 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.

How to Request Information

To request a medical record, please use 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 —

James J. Peters VA Medical Center
Release of Information (Room 9A-37)
130 West Kingsbridge Road
Bronx, New York 10468

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.


Patient Information

Patient Handbook*
Patient Handbook
(Spanish)
*
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)
  * You must have the Adobe Reader to open the forms listed above. Download the latest free Adobe Reader.

Related Links

Notice of Privacy Practices