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1. www.va.gov › find-forms › about-form-21-4142About VA Form 21-4142 - Veterans Affairs

   www.va.gov › find-forms › about-form-21-4142

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   20 wrz 2024 · Get VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA). Use this form to give VA permission to obtain your personal information such as your medical treatment, hospitalizations, psychotherapy, or outpatient care.

   • VA Form 21-4142

     Use this form to provide your written authorization to...

   • VA Form 21-4142a

     VA forms are available at www.va.gov/vaforms. After...

   • About VA Form 21-4142a

     Use VA Form 21-4142 to give us permission to obtain your...

2. www.vba.va.gov › pubs › formsVA Form 21-4142 - Veterans Affairs

   www.vba.va.gov › pubs › forms

   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).

3. www.vba.va.gov › pubs › formsVA Form 21-4142a - Veterans Affairs

   www.vba.va.gov › pubs › forms

   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.

4. www.va.gov › find-forms › about-form-21-4142aAbout VA Form 21-4142a - Veterans Affairs

   www.va.gov › find-forms › about-form-21-4142a

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   20 wrz 2024 · 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.

5. esign.com › hipaa-forms › medical-records-releaseFree VA Form 21-4142 (and 21-4142a) | PDF - eSign

   esign.com › hipaa-forms › medical-records-release

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   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).

6. formswift.com › va-form-21-4142Fillable VA Form 21-4142 | Printable PDF Sample - FormSwift

   formswift.com › va-form-21-4142

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   The VA Form 21-4142 is known as an Authorization and Consent to Release Information to the Department of Veterans Affairs (VA). The form must be completed in order for the VA to obtain information regarding your medical treatments and history.

7. www.benefits.va.gov › compensation › dbq_disabilityexamsPrivate Medical Evidence - Compensation - Veterans Affairs

   www.benefits.va.gov › compensation › dbq_disabilityexams

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   17 sty 2024 · If required, complete your healthcare provider’s release of information form, obtain your records, and submit with your claim, OR. Complete VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA) and VA For 21-4142a, General Release for Medical Provider Information to the Department of Veterans ...