Instructions
A short paragraph at the top says what the form requests, who it is submitted to, that one form is needed per veteran and that it is filed in the veteran's administrative record.
10-0400
Request for Veterans Service Organization (VSO) Access to Computer Patient Record System (CPRS) Read Only
- Agency
- VA
- Revision
- July 2002
- Fillable fields
- 8
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-0400: Request for VSO Access to CPRS Read Only
VA Form 10-0400 is the U.S. Department of Veterans Affairs Request for Veterans Service Organization (VSO) Access to Computer Patient Record System (CPRS) Read Only. VA's form page lists it under VHA. The form says it is used to request access to CPRS Read Only in order to assist a veteran in the preparation of the veteran's claim.
The VSO representative requesting access completes Section 1 and submits the form to the Chief, Health Information Management. The form says a single completed form is necessary for each veteran for whom the representative holds Power of Attorney (POA). The Chief, Health Information Management, or a designee completes Section 2.
The form is one page. It says the form is filed in the veteran's administrative record, along with a copy of the POA, and serves as documentation of the initial disclosure of information. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-0400
Section 1: the request
Name of representative, organization, name of veteran, signature and date, completed by the VSO requesting access.
Section 2: verification
Two statements the reviewer verifies: that the requestor is an accredited representative of an officially-recognized Veterans Service Organization, and that the requestor holds valid POA for the veteran in Section 1. Then a signature and title, and the date.
Note and additional comments
A note that the form is filed in the veteran's administrative record with a copy of the POA and serves as documentation of the initial disclosure of information, followed by a box for additional comments.
How to complete VA Form 10-0400
- 1
Fill in Section 1
Enter the representative's name, the organization and the name of the veteran for whom the representative holds POA.
- 2
Sign and date
The representative signs and dates Section 1.
- 3
Use one form per veteran
The form says a single completed form is necessary for each veteran for whom the representative holds POA.
- 4
Submit to Health Information Management
Submit the form to the Chief, Health Information Management, who or whose designee verifies accreditation and POA in Section 2.
- 5
Filed with the POA
The form says it is filed in the veteran's administrative record along with a copy of the POA.
Why fill Form 10-0400 on indox
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Where it goes
Who receives it
The form says to submit it to the Chief, Health Information Management. It prints no mailing address.
Where it is kept
The form says it is filed in the veteran's administrative record, along with a copy of the POA, and serves as documentation of the initial disclosure of information.
Edition
The current edition is dated JUL 2002, and VA's form page lists its revision date as July 2002.
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Who uses VA Form 10-0400?
The form splits the work between the representative and Health Information Management.
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Questions about Form 10-0400
Who completes VA Form 10-0400?
The VSO representative requesting access completes Section 1. The Chief, Health Information Management, or designee completes Section 2.
What access does the form request?
Access to the Computer Patient Record System (CPRS) Read Only, in order to assist a veteran in the preparation of the veteran's claim.
Can one form cover several veterans?
No. The form says a single completed form is necessary for each veteran for whom the representative holds Power of Attorney (POA).
What does Section 2 verify?
That the requestor is a representative of an officially-recognized Veterans Service Organization, accredited in accordance with Title 38 United States Code (U.S.C.) ss14.626-14.635, and that the requestor holds valid POA for the veteran listed in Section 1.
Where is the form kept?
The form says it is filed in the veteran's administrative record, along with a copy of the POA, and serves as documentation of the initial disclosure of information.