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1. www.vba.va.gov › pubs › formsVA Form 21-4142 - Veterans Affairs

   www.vba.va.gov › pubs › forms

   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.

2. www.va.gov › find-forms › about-form-21-4142About VA Form 21-4142 - Veterans Affairs

   www.va.gov › find-forms › about-form-21-4142

   • Αποθηκευμένο αντίγραφο

   20 Σεπ 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.

3. www.vba.va.gov › pubs › formsVA Form 21-4142a - Veterans Affairs

   www.vba.va.gov › pubs › forms

   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 toll-free at 1-800-827-1000. If you use a Telecommunications Device for the Deaf (TDD), the Federal relay number is 711. VA forms are available at www.va.gov/vaforms.

4. www.benefits.va.gov › compensation › dbq_disabilityexamsPrivate Medical Evidence - Compensation - Veterans Affairs

   www.benefits.va.gov › compensation › dbq_disabilityexams

   • Αποθηκευμένο αντίγραφο

   17 Ιαν 2024 · 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 Private Medical Records ...

5. www.templateroller.com › template › 1728792VA Form 21-4142 - Fill Out, Sign Online and Download Fillable PDF

   www.templateroller.com › template › 1728792

   • Αποθηκευμένο αντίγραφο

   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.

6. www.knowva.ebenefits.va.gov › img › vreVA Form 21-4142 - Veterans Affairs

   www.knowva.ebenefits.va.gov › img › vre

   You can provide this authorization by signing VA Form 21-4142. Federal law permits sources with information about you to release that information if you sign a single authorization to release all your information from all possible sources.

7. esign.com › hipaa-forms › medical-records-releaseFree VA Form 21-4142 (and 21-4142a) | PDF - eSign

   esign.com › hipaa-forms › medical-records-release

   • Αποθηκευμένο αντίγραφο

   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).