About va form 21-4142a | veterans affairs
- Select a language for the TTS:
- UK English Female
- UK English Male
- US English Female
- US English Male
- Australian Female
- Australian Male
- Language selected: (auto detect) - EN
Play all audios:
* Form name: General Release for Medical Provider Information to the Department of Veterans Affairs Form revision date: August 2024 Related to: Disability, Health care WHEN TO USE THIS FORM
Use VA Form 21-4142a to give us permission to get medical provider information from a non-VA source like a private doctor or hospital. This will allow us to gather information like the name
and address of a facility and your medical treatment dates. DOWNLOADABLE PDF Download VA Form 21-4142a (PDF) ONLINE TOOL You can submit your authorization online instead of sending us the
paper form. VA FORM 21-4142 Form name: Authorization to Disclose Information to the Department of Veterans Affairs (VA) Use VA Form 21-4142 to give us permission to obtain your personal
information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.
Download VA Form 21-4142 (PDF) * Securely review, download, and share your medical records. * Find out if you qualify for compensation for a presumptive disability or other service-connected
conditions. * Find out how to file a claim for disability compensation or increased disability compensation.