Get Va 21-4142a 2018-2025

The VA 21-4142a form is essential for granting authorization to obtain medical provider information to the Department of Veterans Affairs. This guide provides step-by-step instructions for filling out the form online, ensuring clarity and ease of use for all individuals.

Follow the steps to complete the VA 21-4142a online.

1. Click the ‘Get Form’ button to access the VA 21-4142a document, allowing you to open the form in your preferred document management tool.
2. In Section I, enter the veteran's identification information. Fill out their full name, social security number, VA file number, date of birth, and service number if applicable.
3. Moving to Section II, provide information for the patient if it is someone other than the veteran. Include their name, social security number, and VA file number where applicable.
4. For Section III, start with Item 9A by filling out the medical provider or facility name. Then specify the dates of treatment in Item 9B, using MM/DD/YYYY format for the required treatment period.
5. Continue with Item 9C by giving the provider or facility's street address, city, state, and ZIP code or postal code.
6. Repeat the process for items 10A to 12C if you have more than one medical provider. Ensure that each section is filled out completely and accurately.
7. Finally, review the entire form for accuracy and completeness. Users can then save changes, print, or share the completed form as needed.

Encourage others to complete their documents online for a smoother and more efficient processing experience.