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  • Va 21-4142 2014

Get Va 21-4142 2014-2025

FORM (both pages) BEFORE SIGNING IN ITEM 11 BELOW. SECTION I - RECORDS TO BE RELEASED TO THE DEPARTMENT OF VETERANS AFFAIRS (VA) I voluntarily authorize and request disclosure (including paper, oral, and electronic interchange) of: All my medical records; including information related to my ability to perform tasks of daily living. This includes specific permission to release: 1. All records and other information regarding my treatment, hospitalization, and outpatient care for my impairment(s).

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How to fill out the VA 21-4142 online

Completing the VA Form 21-4142 is an essential step for users seeking to authorize the release of their medical records to the Department of Veterans Affairs. This guide provides a clear overview of each section, ensuring that the form is filled out correctly and efficiently.

Follow the steps to fill out the VA 21-4142 form online.

  1. Click ‘Get Form’ button to obtain the document and open it in your chosen editor.
  2. In Section I, clearly state the records you are authorizing to be released. This includes all medical records relevant to your treatment and condition. Make sure to include specific permissions for sensitive information, if necessary.
  3. Complete Section II by providing your identification information. Fill in your name, Social Security number, VA file number, date of birth, service number (if applicable), mailing address, and optional email address and telephone number.
  4. If the patient for whom records are being requested is someone other than yourself, complete Section III with their identifying information.
  5. In Section IV, list all sources of medical records. Include names of facilities, physicians, or others that may have relevant information regarding your medical history and treatment. Be detailed in your descriptions.
  6. Section V requires your consent to release these records. Clearly state any limitations to your consent, provide your signature and the date signed, and include your printed name and relationship to the veteran if you are filling out the form on their behalf.
  7. Review all entered information carefully for accuracy. Once confirmed, save the form, and decide whether to download, print, or share it as needed.

Complete the VA 21-4142 form online today to ensure a smooth processing of your medical records request.

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Related content

About VA Form 21-4142 | Veterans Affairs
May 24, 2025 — VA Form 21-4142 is an authorization to disclose personal information from...
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authorization and consent to release information...
This form authorizes the release of treatment records to the VA for benefit eligibility...
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To submit the VA Form 21-4142, you can either send it directly online through the VA’s eBenefits portal or mail it to your local VA office. Ensure that you have included all necessary details to avoid processing delays. The US Legal Forms platform can simplify the process by providing user-friendly templates and guidance for filling out and submitting the VA 21-4142 correctly.

While both forms are related to the release of medical information, VA form 21-4142 focuses on authorization for specific medical records, and VA form 21-4142a is a request to obtain the additional records needed. Understanding the differences ensures you provide the VA with the precise information required for your case. Be sure to select the right form based on your needs.

Filling out the VA form 21-4142 involves providing your personal information, specifying the records you want released, and signing the authorization. Make sure to double-check your entries for accuracy and completeness to prevent processing delays. If needed, platforms like USLegalForms offer step-by-step assistance to ensure you navigate the form correctly.

To achieve a 100% unemployability rating from the VA, you need to file a claim demonstrating your inability to maintain gainful employment due to service-related conditions. You can present medical evidence, work history, and other supporting documents to strengthen your case. Utilizing the VA 21-4142 form may help streamline the process by authorizing the release of critical medical records.

The VA Form 21-4142 is typically completed by the veteran or claimant. You must provide your personal information and identify the healthcare providers from whom you want the VA to obtain records. Ensure that the details are correct to prevent any delays in processing your claims. Relying on the VA 21-4142 allows you to authorize the VA to gather necessary documentation for your case.

VA Form 21-4142a is used to collect specific information about your healthcare providers. This form allows the VA to request additional records that support your disability claim. Make sure to fill it out accurately to ensure comprehensive records are obtained. Using the VA 21-4142 along with 4142a can enhance your claim's chance for approval.

To submit a claim for Total Disability based on Individual Unemployability (TDIU), you need to complete the VA Form 21-8940. Include medical evidence, work history, and any necessary documentation that supports your claim. Once completed, send the form to your regional VA office. Additionally, using the VA 21-4142 can help by allowing the VA to obtain relevant medical records to support your TDIU claim.

You should send the completed VA Form 21-4142 to the VA regional office that is managing your claim. This information is typically provided in the instructions accompanying your form. Always double-check that you have the correct address to avoid delays. Submitting the VA 21-4142 to the right location helps ensure your request for records is processed efficiently.

The VA Form 21-4142 must be sent to the Department of Veterans Affairs. This form authorizes the VA to request your medical records from different healthcare providers. It is important that you send this form to the correct VA regional office handling your claim. Using the VA 21-4142 correctly can streamline your claims process.

100% VA disability means that the VA has officially rated your service-related disabilities as completely disabling. In contrast, unemployability is a status for veterans who cannot work due to their disabilities, even if their combined rating is less than 100%. Understanding these differences is important for navigating your benefits and ensuring you receive the support you need.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232