Cheyenne VA Medical Center
Request Your Medical Records
Our Release of Information staff will be happy to assist you with requests for your medical records. We also assist providers with completing forms for patients.
We can assist you with the following:
- access to your medical records
- obtaining copies of your medical records
- completion of forms for benefits, insurance, and other reasons
How to Request Information
Cheyenne VA Medical Center
Release of Information (136D)
2360 E. Pershing Blvd.
Cheyenne, WY 82001
|Cheyenne VA Medical Center
Room B1-72 (Buffalo Building, First Floor
in the main entrance hallway)
|Loveland Community Clinic
5200 Hahns Peak Dr.
|Monday-Thursday 8 a.m. to 4:30 p.m.
Friday 8 a.m. to 3:30 p.m.
|Monday-Friday 8 a.m. to 4:30 p.m.|
What to Submit
Please read the directions below on what is needed to request Veterans Health Administration Records:
First-Party Requests - If you would like to request a copy of your medical records for yourself, you can either send us a written request that includes they specific records you want, your handwritten signature, and a date, or you can complete a VA Form 10-5345a, Individuals’ Request for a Copy Of Their Own Health Information.
Community Providers - Please fax us a written request on your fax coversheet/letterhead with the Veteran’s name and last 4 of their SSN (preferred) and/or date of birth, and what records you need to 307-778-7560. The written request must include a handwritten signature in accordance with the Privacy Act 5 U.S.C. 552a. The signature does not have to be by the Veteran, but by the staff member requesting the records for the purposes of treatment.
Third-Party Requests – If you would like us to disclose your records to anyone other than you, please complete a VA Form 10-5345, Request for and Authorization to Release Health Information. We will also accept any authorization that is HIPAA compliant.
HITECH Requests – Health Information Technology for Economic and Clinical Health Act (HITECH) requests cannot be accepted to disclose records that are protected by the Privacy Act, 5 U.S.C 552a. Please provide a Health Insurance Portability and Accountability (HIPPA) complaint authorization signed by the Veteran or the Veteran’s legal representative.
Record Request Status Checks – Please fax a written status check request to 307-778-7560.
**Note – Electronic signatures are not accepted.
Please allow 20-business days from the date the request is received for processing.
Veterans Health Information Exchange program
VA is changing electronic health information sharing options to improve care coordination and continuity of care.
VA electronically shares the right information at the right time with participating community care providers who treat you, in order to help you and your health care team make the most informed treatment decisions. This instant exchange of information can dramatically improve patient safety, especially during emergency situations. VA is committed to protecting Veteran privacy. VA only shares Veteran health information with specific community providers when a Veteran is seeking medical care. Only community providers and organizations that have partnership agreements with VA and are part of VA’s approved, trusted network may receive VA health information. For more information about the Veterans Health Information Exchange program, click here.
VA Form 10-10164 – Opt-out of Health Information Sharing
Questions? Please contact the Health Information Management Section at 307-778-7550 ext. 7306.