Please rate Va Form 21 4142 Aug 2024
You should not complete this form unless you want the VA to obtain private treatment records on your behalf.
Records you obtain: If you have already provided these records or intend to obtain them yourself, there is no need to fill out this form.
VA records: This form is not needed to request VA medical records.
Expires: If you do not revoke this authorization, it will automatically expire in 12 months from the date you sign and date the form.
Fastest method: VA recommends submitting correspondence electronically as this is the fastest method of receipt.
VA Form 21-4142a: This file also holds the General Release for Medical Provider Information to the Department of Veterans Affairs (VA).
| Question | Answer |
|---|---|
| Form Name | VA Form 21-4142 |
| Form Length | 5 pages |
| Fillable? | Yes |
| Fillable fields | 145 |
| Avg. time to fill out | 25 min |
| Edition | AUG 2024 |
| Who signs | The person authorizing disclosure |
| Expires | 12 months from the date you sign and date the form |
| Matches the agency's file | Yes, checked October 2, 2026 |
| Other names | VA Form 21-4142, VA 21-4142, 21-4142, VA Form 21 4142, VA Form 21-4142a, 21-4142a, VA Form 4142, Authorization to Disclose Information to the Department of Veterans Affairs |
| Official source | VA Form 21-4142 (Rev AUG 2024), Department of Veterans Affairs |
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Please rate Va Form 21 4142 Aug 2024
