VA Eastern Colorado Health Care System (Release of Information Office) fax number

Fax destination details

Department

Release of Information (ROI) Office

Purpose

Submit requests for medical records via the Release of Information (ROI) office. First-party requests use VA Form 10-5345a (Individuals' Request for a Copy of Their Own Health Information) and third-party requests use VA Form 10-5345 (Request for and Authorization to Release Health Information). Fax completed forms to 720-723-6010; address records to VA Eastern Colorado Health Care System ROI, 1700 N. Wheeling St., Aurora, CO 80045.

Form

VA Form 10-5345; VA Form 10-5345a — Request for and Authorization to Release Health Information (VA Form 10-5345) and Individuals' Request for a Copy of Their Own Health Information (VA Form 10-5345a)

Address

1700 N Wheeling St, Aurora, CO 80045

Voice phone

720-857-5980

Website

Visit organization website

Before you send

• Confirm that this exact department handles your document or request.
• Check the organization website or call its main line for the current fax number.
• Include a cover sheet and any case, member, claim, or form reference required.
• Keep the delivery confirmation with your submission records.

Complete the appropriate form with patient identifying information and signatures; fax to the ROI office for processing. See VA forms: VA Form 10-5345 and VA Form 10-5345a.