Search results
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...
- About VA Form 21-4142a
Use VA Form 21-4142a to give us permission to get medical...
- Supporting Forms For VA Claims
Get VA Form 21-4142 to download. Submit a lay or witness...
- VA Form 21-4142a
VA DATE STAMP. (DO NOT WRITE IN THIS SPACE) GENERAL RELEASE...
- Compensation
If you received treatment at a military hospital or clinic...
- VA Form 21-4142
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).
20 wrz 2024 · 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.
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 DATE STAMP. (DO NOT WRITE IN THIS SPACE) GENERAL RELEASE FOR MEDICAL PROVIDER INFORMATION TO THE DEPARTMENT OF VETERANS AFFAIRS (VA) VA DATE STAMP. (DO NOT WRITE IN THIS SPACE) INSTRUCTIONS: Before completing this form, read the Privacy Act and Respondent Burden on page 2.
17 sty 2024 · If you received treatment at a military hospital or clinic after your discharge, please include facility information and the date ranges of your medical treatment records for your claimed conditions when completing VA Forms 21-4142 and 21-4142a.
Authorize The Release Of Non-VA Medical Information To VA | Veterans Affairs. An official website of the United States government. Here’s how you know. The .gov means it’s official. The site is secure. The https:// ensures that you're connecting to the official website and that any information you provide is encrypted and sent securely.
