Αποτελέσματα Αναζήτησης
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 · 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.
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.
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 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.
17 Ιαν 2024 · View/download VA Form 21-4142 and VA Form 21-4142a. Tell us about your Federal records (from any federal agency*) and we will gather these on your behalf.
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).
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.
