United States Department of Veterans Affairs

G.V. (Sonny) Montgomery VA Medical Center

Release of Information

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
  • requests to amend your medical records
  • requests for name changes
  • completion of forms for benefits, insurance, and other reasons

The Release of Information Staff is expert in our patients' rights and their medical records.

The Release of Information Office is located in the Patient Care Center/Module A on the 1st floor of the VAMC.  The telephone number is (601) 364-1566 or 1-800-949-1009 ext. 1566.

How to Request Information

To request your medical records, please complete and sign the requested information for the appropriate form listed in the column to the right.  Mail or fax it to:

G.V. (Sonny) Montgomery VAMC
Release of Information/Medical Records (136C)
1500 woodrow Wilson Ave.
Jackson, MS 39216

Fax:  (601) 364-1230

Because forms must contain an original signature, e-mailed forms cannot be accepted.

Requests for records will take approximately 20 days to process.

Fees

There is no cost to send copies directly to another health care provider. If copies are for a patient's personal use, photocopying fees may be assessed.


Patient Information

Patient Information
Eligibility
Make, Change, or Cancel an Appointment 
Advance Directives 

Release of Information Forms

Request for and Authorization to Release Medical Records or Health Information (VA 10-5345) 
Individuals' Request for a Copy of Their Own Health Information (VA 10-5345a) 

Related Links

Notice of Privacy Practices