Patient Health & Appeals
10-5345 — Request for and Authorization to Release Health Information
Use Form 10-5345 to request and authorization to release health information.
How 10-5345 fits into a repeat PDF workflow
10-5345 — Request for and Authorization to Release Health Information is listed in the Patient Health & Appeals catalog. Use it for repeat patient health & appeals work where the official PDF layout needs to stay intact. Treat the blank PDF as the controlled starting point: keep the official layout intact, then add reviewed fields and mappings before using it for live records.
- Template setup: open the blank PDF in DullyPDF, run field detection, and review text boxes, checkboxes, radio groups, dates, and signature areas before saving the template.
- Data fill: map the detected fields to CSV, Excel, or JSON row headers so the same reviewed PDF can be filled from repeat records. Use SQL or TXT imports for schema mapping, not direct row filling.
- Output paths: download the completed PDF, collect respondent answers with Fill By Link, call API Fill, or route the prepared record into a signature workflow.
The catalog keeps 2 pages, file size, category, and source attribution to va.gov visible before automation starts, which helps teams confirm they are working from the right official blank form before saving a template.