Healthcare Forms
Browse official and fillable healthcare PDFs. Open a form to fill it online, download a blank copy, or print it for filing.
Find the right healthcare form
Healthcare forms are commonly used by patients, clinics, benefits teams, caregivers, and medical administrators. This hub organizes 343 fillable PDFs so you can find the right document, fill it online, download a blank copy, and keep a record for filing.
Filing checklist
- Open the form detail page and verify the agency, year, revision date, and source link.
- Read the official instructions before submitting the completed form.
- Confirm the current form and submission method with the provider, insurer, or benefits office.
- Review privacy requirements before sharing completed medical or insurance paperwork.
343 Healthcare Forms
Page 12 of 15
VA Form 10-252(2020)
Authorization to Release Protected Health Information to State/Local Public Health Authorities
Official Department of Veterans Affairs 10-252 for Authorization to Release Protected Health Information to State/Local Public Health Authorities, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2520(2008)
Prosthetic Service Card Invoice
Official Department of Veterans Affairs 10-2520 for Prosthetic Service Card Invoice, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2570(2007)
VA Staff Dental Outpatient Record
Official Department of Veterans Affairs 10-2570 for VA Staff Dental Outpatient Record, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2570G(2015)
Dental Outpatient Emergency-Referral & Treatment - Order from SDC #F04736
Official Department of Veterans Affairs 10-2570G for Dental Outpatient Emergency-Referral & Treatment - Order from SDC #F04736, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-259(2021)
Revocation of Authorization for Release of Release of Individually-Identifiable Health Information
Official Department of Veterans Affairs 10-259 for Revocation of Authorization for Release of Release of Individually-Identifiable Health Information, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2614D-2A(1992)
Report of Seizure - Medical Record
Official Department of Veterans Affairs 10-2614D-2A for Report of Seizure - Medical Record, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2614D-3A(2000)
Medical Record Allergy Treatment
Official Department of Veterans Affairs 10-2614D-3A for Medical Record Allergy Treatment, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2723(1989)
Request for Medical Media Production Service - Fillable
Official Department of Veterans Affairs 10-2723 for Request for Medical Media Production Service - Fillable, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2850D(2011)
Application for Health Professions Trainees
Official Department of Veterans Affairs 10-2850D for Application for Health Professions Trainees, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2859-3(1989)
Request for Receipt for Prosthetic Appliances or Services
Official Department of Veterans Affairs 10-2859-3 for Request for Receipt for Prosthetic Appliances or Services, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2913(1989)
Report of Patient's Condton and Nursing Unit Activities - Order from SDC #F01726
Official Department of Veterans Affairs 10-2913 for Report of Patient's Condton and Nursing Unit Activities - Order from SDC #F01726, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-2920(2005)
Authorization for Release of Patient Funds
Official Department of Veterans Affairs 10-2920 for Authorization for Release of Patient Funds, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-305(S)(2021)
Your Rights To Seek Further Review of Program of Comprehensive Assistance for Family Caregivers (PCAFC) Decisions - Spanish
Official Department of Veterans Affairs 10-305(S) for Your Rights To Seek Further Review of Program of Comprehensive Assistance for Family Caregivers (PCAFC) Decisions - Spanish, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-320(2024)
Veteran Reimbursement Claim Form
Use this form to request reimbursement for these expenses: Out-of-pocket emergency prescription expenses from a pharmacy that's not in VA's network, and Out-of-pocket expenses for unauthorized emergency care at non-VA facilities
VA Form 10-323(2022)
Veteran Repayment Plan (RPP) Agreement
Use this form to set up a monthly repayment plan for VA health care copay bills. Mail your completed form to your VA Consolidated Patient Account Center (CPAC). Don't mail it to the VA facility where you receive care. Find the mailing address for your CPAC
VA Form 10-328(2028)
REASONABLE ACCOMMODATION COORDINATOR (RAC) INTAKE & TRACKING FORM PROCESSING NOTIFICATIONS AND REQUESTS FOR OPTING OUT OF FUNCTIONS RELATED TO REPRODUCTIVE HEALTH CARE
Official Department of Veterans Affairs 10-328 for REASONABLE ACCOMMODATION COORDINATOR (RAC) INTAKE & TRACKING FORM PROCESSING NOTIFICATIONS AND REQUESTS FOR OPTING OUT OF FUNCTIONS RELATED TO REPRODUCTIVE HEALTH CARE, sourced from the VA public forms catalog for veterans benefits, health care, education, records,...
VA Form 10-330(2028)
EXEMPTION AND ACCOMMODATION FORM EMPLOYEE REQUEST TO BE EXCUSED FROM AN ASPECT OF REPRODUCTIVE HEALTH
Official Department of Veterans Affairs 10-330 for EXEMPTION AND ACCOMMODATION FORM EMPLOYEE REQUEST TO BE EXCUSED FROM AN ASPECT OF REPRODUCTIVE HEALTH, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-3542(2025)
Veteran/Beneficiary Claim for Reimbursement of Travel Expenses
Use this travel reimbursement form (VA Form 10-3542) when you want to ask us to pay you back for travel expenses related to your health care.
VA Form 10-387(2025)
Medical Foster Home Caregiver Application
Official Department of Veterans Affairs 10-387 for Medical Foster Home Caregiver Application, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-394(2025)
Subcutaneous Insulin Infusion (SCII) Pump Patient Log
Official Department of Veterans Affairs 10-394 for Subcutaneous Insulin Infusion (SCII) Pump Patient Log, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-4555B(1998)
Certificate of Medical Feasibility
Official Department of Veterans Affairs 10-4555B for Certificate of Medical Feasibility, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-493B(2016)
CHAMPVA Benefits Election Affirmation
Official Department of Veterans Affairs 10-493B for CHAMPVA Benefits Election Affirmation, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
VA Form 10-5345(2021)
Request for and Authorization to Release Health Information
Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization.
VA Form 10-5345A(2021)
Individuals' Request for a Copy of Their Own Health Information
Official Department of Veterans Affairs 10-5345A for Individuals' Request for a Copy of Their Own Health Information, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.
Common mistakes to avoid
- Missing patient identifiers, policy numbers, dates of service, or provider details.
- Sending protected health information to the wrong recipient.
- Forgetting consent, release, signature, or representative authorization fields.