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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). VA forms are available at www.va.gov/vaforms.
20 Σεπ 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.
1 Μαρ 2018 · Fill out and download VA Form 21-4142 Authorization to Disclose Information to the Department of Veterans Affairs online. Get a PDF or Word version of the blank form, or save the filled form as a ready-to-print PDF.
Use this form to provide the name of the provider or facility you have received treatment from to the VA. For more information, contact us at https://ask.va.gov, or call us
23 Απρ 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).
31 Αυγ 2017 · View, download and print fillable Va 21-4142 - Authorization To Disclose Information To The Department Of Veterans Affairs (va) in PDF format online. Browse 3 Va Form 21-4142 Templates collected for any of your needs.
20 Σεπ 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.
