INSTRUCTIONS: Before completing this form, read the Privacy Act and Respondent Burden on page 2. Use this form to provide the name of the provider or facility you have received …
VA Form 21-4142A - Fill Out, Sign Online and Download Fillable …
Download Fillable Va Form 21-4142a In Pdf - The Latest Version Applicable For 2026. Fill Out The General Release For Medical Provider Information To The Department Of Veteran Affairs …
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INSTRUCTIONS - COMPLETE AND ATTACH THIS FORM WITH A SIGNED VA FORM 21-4142, AUTHORIZATION TO DISCLOSE INFORMATION TO THE DEPARTMENT OF VETERANS …
Va Form 21 4142a 2020-2025 - Fill and Sign Printable Template …
Complete Va Form 21 4142a 2020-2025 online with US Legal Forms. Easily fill out PDF blank, edit, and sign them. Save or instantly send your ready documents.
INSTRUCTIONS: Before completing this form, read the Privacy Act and Respondent Burden on page 2. Use this form to provide your written authorization to obtain your treatment records, so …
Free VA Form 21-4142 (and 21-4142a) | PDF - eSign
Apr 23, 2024 · While VA Form 21-4142 authorizes the Department to access a veteran’s non-VA treatment medical records, Form 21-4142a must be completed at the same time to disclose all …
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Fillable Va Form 21-4142a - General Release For Medical Provider ...
Aug 31, 2017 · View, download and print fillable Va 21-4142a - General Release For Medical Provider Information in PDF format online. Browse 3 Va Form 21-4142 Templates collected for …
About VA Form 21-4142 - Veterans Affairs
Dec 18, 2025 · 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 …
VA Form 21-4142A 2024-2025 - Fill Forms Online - PDF Guru
Fill out VA Form 21-4142A accurately with our guide. Learn how to complete official forms and download them with PDF Guru today!
Completing VA Forms 21-4142 and 21-4142a Again | Berry Law
Feb 21, 2025 · This form allows the VA to request medical records, treatment notes, and diagnostic tests from non-VA providers. Veterans must complete one form per healthcare …