Va 21 4142 2021-2025 Form
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People also ask va 21 4142a fillable
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When to use VA form 21-4142?
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.
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Who fills out VA Form 21 4192?
Your most recent employer must complete and submit this form.
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How to submit VA form 21 4142a?
After completing the form, mail to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. NOTE: You may complete the form online or by hand.
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What is the difference between 4142 and 4142a?
VA Form 21-4142 and VA Form 21-4142a 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 medical providers or facilities that administered medical treatment to the veteran.
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What is a VA Form 21-4142 authorization to disclose information?
The Veterans Benefits Administration (VBA) uses VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA), to request private medical records and information regarding the source of records in support of claims for compensation and/or pension benefits.
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What is the difference between VA form 21-4142 and 21 4142a?
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 Affairs (VA); submit completed forms with your claim and VA will attempt to obtain your records through our ...
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How to submit VA form 21 4142a?
After completing the form, mail to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444. NOTE: You may complete the form online or by hand.
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What is VA form 21 22a used for?
NOTE: If you prefer to have a veterans service organization assist you with your claim instead of an individual please complete VA Form 21-22, Appointment of Veterans Service Organization as Claimant's Representative. See Page 3 on how to submit completed form. VA forms are available at .va.gov/vaforms.
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