[Code of Federal Regulations]
[Title 38, Volume 1]
[Revised as of January 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR1.475]

[Page 29-30]
 
            TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF
 
                CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS
 
PART 1_GENERAL PROVISIONS--Table of Contents
 
Sec. 1.475  Form of written consent.

    (a) Required elements. A written consent to a disclosure under 
Sec. Sec. 1.460 through 1.499 of this part must include:
    (1) The name of the facility permitted to make the disclosure (such 
a designation does not preclude the release of records from other VA 
health care facilities unless a restriction is stated on the consent).
    (2) The name or title of the individual or the name of the 
organization to which disclosure is to be made.
    (3) The name of the patient.
    (4) The purpose of the disclosure.
    (5) How much and what kind of information is to be disclosed.
    (6) The signature of the patient and, when required for a patient 
who is a minor, the signature of a person authorized to give consent 
under Sec. 1.464 of this part; or, when required for a patient who is 
incompetent or deceased, the signature of a person authorized to sign 
under Sec. 1.465 of this part in lieu of the patient.
    (7) The date on which the consent is signed.
    (8) A statement that the consent is subject to revocation at any 
time except to the extent that the facility which is to make the 
disclosure has already acted in reliance on it. Acting in reliance 
includes the provision of treatment services in reliance on a valid 
consent to disclose information to a third party payer.

[[Page 30]]

    (9) The date, event, or condition upon which the consent will expire 
if not revoked before. This date, event, or condition must ensure that 
the consent will last no longer than reasonably necessary to serve the 
purpose for which it is given.
    (b) Expired, deficient, or false consent. A disclosure may not be 
made on the basis of a consent which:
    (1) Has expired;
    (2) On its face substantially fails to conform to any of the 
requirements set forth in paragraph (a) of this section;
    (3) Is known to have been revoked; or
    (4) Is known, or through a reasonable effort could be known, by 
responsible personnel of VA to be materially false.
    (c) Notification of deficient consent. Other than the patient, no 
person or entity may be advised that a special consent is required in 
order to disclose information relating to an individual participating in 
a drug abuse, alcoholism or alcohol abuse, HIV, or sickle cell anemia 
program or activity. Where a person or entity presents VA with an 
insufficient written consent for information protected by 38 U.S.C. 
7332, VA must, in the process of obtaining a legally sufficient consent, 
correspond only with the patient whose records are involved, or the 
legal guardian of an incompetent patient or next of kin of a deceased 
patient, and not with any other person.
    (d) It is not necessary to use any particular form to establish a 
consent referred to in paragraph (a) of this section, however, VA Form 
10-5345, titled Request for and Consent to Release of Medical Records 
Protected by 38 U.S.C. 7332, may be used for such purpose.

(Authority: 38 U.S.C. 7332(a)(2) and (b)(1))