Official VA Form

VA Form 10-10163

Request for and Permission to Participate in Sharing Protected Health Information through Health Information Exchanges

VA Form 10-10163 — Request for and Permission to Participate in Sharing Protected Health Information through Health Information Exchanges is an official U.S. Department of Veterans Affairs form used for health care. The current version was last revised 2021-10-05. 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.

Download the official PDF (VA.gov) →

Last revised: 2021-10-05
First issued: 2022-12-05
Pages: 1
Administered by: VHA

Health care

Frequently asked questions

What is VA Form 10-10163 used for?

Request for and Permission to Participate in Sharing Protected Health Information through Health Information Exchanges. It is an official VA form in the Health care category, administered by VHA.

Where can I download the current VA Form 10-10163?

Download the official PDF from VA.gov here: https://www.va.gov/vaforms/medical/pdf/10-10163-fill.pdf (last revised 2021-10-05).

How long is VA Form 10-10163?

VA Form 10-10163 is 1 page long, last revised 2021-10-05.

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

You are not the first person to deal with this

BaseNeed is a members-only community for service members, veterans, spouses and their families. Nothing posted inside is public — not on Google, not on Facebook. That is the point: people talk about moves, money and paperwork there, and that only works behind a door.

Join free — 30 seconds →

No account needed for these: VA facilities · BAH calculator · Jobs · Housing

More Health care forms

VA Form 10-3542 — Veteran/Beneficiary Claim for Reimbursement of Travel Expenses
VA Form 10-7959C — CHAMPVA—Other Health Insurance (OHI) Certification
VA Form 10-10EZ — Instructions and Enrollment Application for Health Benefits
VA Form 21-4142a — General Release for Medical Provider Information to the Department of Veterans Affairs
VA Form 21-0845 — Authorization to Disclose Personal Information to a Third Party
VA Form 10-0137 — VA Advance Directive: Durable Power of Attorney for Health Care and Living Will
VA Form 21-4142 — Authorization to Disclose Information to the Department of Veterans Affairs (VA)
VA Form 21P-8416 — Medical Expense Report

Nearby form numbers

VA Form 10-10145 — Veterans Health Administration (VHA) Veterans Choice Program Provider Agreement
VA Form 10-10152 — Reimbursement Request for Qualifying Adoption Expenses
VA Form 10-10154 — Employee Incentive Scholarship Program—Mobility Agreement
VA Form 10-10164 — Opt-Out of Sharing Protected Health Information Through Health Information Exchanges
VA Form 10-10169 — Volunteer Consent Form
VA Form 10-10171 — Veterans Health Administration (VHA) Veterans Care Agreement