Official VA Form

VA Form 10-259

Revocation of Authorization for Release of Release of Individually-Identifiable Health Information

VA Form 10-259 — Revocation of Authorization for Release of Release of Individually-Identifiable Health Information is an official U.S. Department of Veterans Affairs form used for health care, records. The current version was last revised 2021-03-22. 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: 2021-03-22
First issued: 2022-06-22
Pages: 1
Administered by: VHA

Health careRecords

Frequently asked questions

What is VA Form 10-259 used for?

Revocation of Authorization for Release of Release of Individually-Identifiable Health Information. It is an official VA form in the Health care, Records categories, administered by VHA.

Where can I download the current VA Form 10-259?

Download the official PDF from VA.gov here: https://www.va.gov/vaforms/medical/pdf/10-259%20Revocation%20of%20Authorization%20for%20Release%20of%20Release%20of%20Individually-Idenrifiable%20Health%20Information.pdf (last revised 2021-03-22).

How long is VA Form 10-259?

VA Form 10-259 is 1 page long, last revised 2021-03-22.

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

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