VAFORMS.NET – VA Form 21-4142A – General Release for Medical Provider Information to the Department of Veterans Affairs – A VA Form 21-4142A – General Release of Information for a Medical Professional is a document that authorizes the Department of Veterans Affairs (VA) to obtain medical provider information for a veteran. This information may include the name and address of the medical facility where the veteran received treatment, dates of medical treatment, and so on. This form also allows the VA to obtain personal medical information, such as the patient’s diagnosis, medical treatment, hospitalizations, psychotherapy, and outpatient care.
Download VA Form 21-4142A – General Release for Medical Provider Information to the Department of Veterans Affairs
| Form Number | VA Form 21-4142A |
| Form Title | General Release for Medical Provider Information to the Department of Veterans Affairs |
| Edition Date | June 2022 |
| File Size | 1 MB |
What is VA Form 21-4142A?
Whether you served during World War II or now, you may be wondering what VA Form 21-4142A is. Basically, this form authorizes the Department of Veterans Affairs to share information that it collects from you. The form will ask for certain personal information about you, such as your social security number, and will require you to provide a statement supporting your claim for benefits. The information collected on the form will help the Department of Veterans Affairs evaluate the validity of your claim.
The Department of Veterans Affairs (VA) provides disability compensation benefits to eligible veterans and their dependents. Those who qualify can be paid tax-free benefits for life. Those who are disabled by service-related injuries or illnesses may be eligible to receive benefits as well.
Where Can I Find a VA Form 21-4142A?
When filing for disability benefits, you will need to provide thorough documentation of your condition. Although much of the medical evidence for a claim can come from the VA healthcare system, you should also provide evidence from non-VA sources. This evidence may include doctor’s notes, diagnostic tests, and treatment records.
After completing the form, you must submit it to the VA for processing. If possible, you should submit private medical records along with the application. This will speed up the processing time. You will then be contacted for a Compensation and Pension (C&P) exam. Be sure to attend your scheduled appointment.
Generally, it is possible for the VA to request copies of medical records from community medical providers. In order to do so, the medical provider must provide a medical release. This form must be completed for each hospital and community doctor who treats you. However, you should note that submitting medical records to the VA may cause your claim to be taken out of the Fully Developed Claims process. Therefore, VA advocates recommend submitting your own records.
VA Form 21-4142A – General Release for Medical Provider Information to the Department of Veterans Affairs
Whether you’re applying for VA benefits or seeking additional medical care, you must submit the appropriate forms. This includes military personnel records and medical evidence that you have received significant injuries during your service. In addition to submitting the appropriate forms, veterans must also provide the VA with certain information to expedite their claims. The information included in the forms should include where you received care when it occurred, and for how long.
When you file for VA benefits, it is important to note that the information you provide may be used for purposes related to your medical care, including determining eligibility for benefits or enrolling in a health plan. Because this information will be sent to the Veterans Benefits Administration, it may no longer be subject to the privacy protections of the Federal Privacy Act or HIPAA Privacy Rule.
VA Form 21-4142A Example
