Medical Records Release Form For Veterans Administration
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FAQ
VA Form 21-4142: A 4-Step Quick Guide for Veterans 4 Steps to Filling Out VA Form 21-4142. Step One: Complete Identifying Information. Step Two: Source of Records Information. Step Three: Records Released to VA. Step Four: Sign and Authorize for Release of Information to VA. NEED MORE ASSISTANCE?
Hear this out loud PauseHow to submit a medical records request. You'll need to fill out an Individuals' Request for a Copy of Their Own Health Information (VA Form 10-5345a). Submit your completed form to your VA health facility's medical records office. This office is also called a Release of Information Office.
Hear this out loud PauseRequests for certain types of restricted records require specific authorization from the veteran or person of record. You will be notified if this type of authorization is required and may receive NA Form 13036, Authorization for Release of Military Medical Patient Records.
VA Form 21, APPLICATION FOR ACCREDITATION AS SERVICE ORGANIZATION REPRESENTATIVE.
How to Transfer Your Records to VA View and download your health records on the Secure Patient Portal. This only applies to health records classified as sensitive. Fill out and submit a Form SF 180, Request Pertaining to Military Records. Submit a request in-person at your nearest military hospital or clinic.