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VA Form 21-4142A General Release for Medical Provider Information to the Department of Veteran Affairs (VA)
What Is VA Form 21-4142A?
VA Form 21-4142A, General Release For Medical Provider Information to the Department of Veterans Affairs , is a form used for gathering private provider information about a Veteran's private providers for the U.S. Department of Veterans Affairs (VA). The release is submitted along with the following paperwork:
- VA Form 21-526, Veterans Application for Compensation and/or Pension.
- VA Form 21-526B, Veteran's Supplemental Claim for Compensation.
- VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs.
The latest version of the form was released on March 1, 2018 . A fillable VA Form 21-4142A is available for digital filing and download below or can be found on the VA Forms website.
How to Fill Out VA Form 21-4142A?
The VA 21-4142A is distributed as part of the main VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, or can be downloaded and filed separately.
The form is distributed without any official filing guidelines. Step-by-step VA Form 21-4142A instructions can be found below.
- Section I ("Veteran's Identification Information") requires the veteran's name, Social Security Number (SSN), VA file number, service number, and date of birth.
- Section II ("Patient Identification for Records the VA is Requesting") is filed in case the records are requested for anyone other than the veteran.
- Section III ("Medical Provider Information") identifies the healthcare provider or medical facility and provides the dates of treatment.
There is no need to fill out the form If the veteran has the ability to obtain the records and personally submit them to the VA. Submitting the VA 21-4142A will lengthen claim processing time.
Download VA Form 21-4142A General Release for Medical Provider Information to the Department of Veteran Affairs (VA)
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