Official VA Form

VA Form 10-10116

Revocation of Authorization for Use & Release of Individually Identifiable Health Information for Veterans Health Administration (VHA) Research

VA Form 10-10116 — Revocation of Authorization for Use & Release of Individually Identifiable Health Information for Veterans Health Administration (VHA) Research is an official U.S. Department of Veterans Affairs form. The current version was last revised 2015-08-02. It is 1 page long. Download the up-to-date PDF below — BaseNeed syncs form data directly from VA.gov so you always get the current edition.

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Frequently asked questions

What is VA Form 10-10116 used for?

Revocation of Authorization for Use & Release of Individually Identifiable Health Information for Veterans Health Administration (VHA) Research. It is an official VA form, administered by VHA.

Where can I download the current VA Form 10-10116?

Download the official PDF from VA.gov here: https://www.va.gov/vaforms/medical/pdf/vha-10-10116.pdf (last revised 2015-08-02).

How long is VA Form 10-10116?

VA Form 10-10116 is 1 page long, last revised 2015-08-02.

Always the current version — synced from VA.gov. BaseNeed is not affiliated with the U.S. Department of Veterans Affairs.

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