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20 wrz 2024 · Download VA Form 21-4142 (PDF) Online tool. You can submit your authorization online instead of sending us the paper form. Helpful links related to VA Form 21-4142. Securely view, download, and share your medical records. Learn about the steps for filing a claim for disability compensation or increased disability compensation.
Use this form to provide your written authorization to obtain your treatment records, so the VA can get the information required to process your claim. For more information, you can contact us online through Ask VA: https://ask.va.gov/ or call us toll-free at 1-800-827-1000 (TTY: 711).
1 mar 2018 · Fill out and download VA Form 21-4142 Authorization to Disclose Information to the Department of Veterans Affairs online. Get a PDF or Word version of the blank form, or save the filled form as a ready-to-print PDF.
23 kwi 2024 · VA Form 21-4142 and Form 21-4142a are medical records release forms that a patient (veteran) must complete in order to release private health information to the Department of Veterans Affairs (VA).
26 lip 2024 · Get VA Form 21-4142 to download. Submit a lay or witness statement to support a VA claim (VA Form 21-10210) When to use this form. Use this form to submit a formal statement to support your VA claim—or the claim of another Veteran or eligible family member. People also sometimes call this statement a “buddy statement.” How to submit this form.
VA forms are available at www.va.gov/vaforms. After completing the form, mail to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. SECTION I - VETERAN'S IDENTIFICATION INFORMATION. NOTE: You may complete the form online or by hand.
2 lis 2020 · VA Form 21-4142a General Release for Medical Provider Information to The ⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2900-0858 can be found here:
