Va form 214142a, general release for medical information to the. Once this form is completed and submitted, the va can then make a decision on benefits that the veteran will be. Va form 214142a, general release for medical provider information to the department of veterans affairs, is a form used for gathering private provider. Va form 214142a download fillable pdf or fill online. General release for medical provider information to the department of veterans affairs va fillable file type. Appointment of individual as claimants representative fillable file type. Va form 214142a download fillable pdf or fill online general. Department of veterans affairs, united states federal legal forms and united states legal forms. Benefit from a digital solution to generate, edit and sign contracts in pdf or word format online.
Request for dd 214 or other military records nara sf 180. Va form 21 4142a is often used in va 214142 forms, u. Va form 214142 is a fairly straightforward form, requiring the veterans name, social security number, and va file number. A va form 214142 is known as an authorization and consent to release information to the us department. In addition, the veteran will need to list the sources where the va can find pertinent information, as well as the dates that medical treatments occurred. This instructional video will help explain and walk you through filling out va form 214124, authorization to disclose information to the.
Va form 214142 authorization for release of information. This is a document that requires a veteran to provide his or her consent so that the va may obtain the necessary information regarding their medical history and any treatments they may have received. Authorization to disclose information to the department of veterans affairs va fillable file type. Form va 214142 authorization and consent to release. Fill out the general release for medical provider information to the.
Sf form 180 request pertaining to military records. Va 214142 2014 2019 printable and fillable, blank pdf. Last name first name middle name of veteran type or print. Additional va forms 214142a can be obtained from the va forms web site at. An indepth look at va benefits and advocacy strategies. Va form 214142 authorization and consent to release information to the department of veterans affairs. To the department of veterans affairs va instructions complete and attach this form with a signed va form 214142, authorization to disclose information to the department of veterans affairs va. Organization of veterans advocates nova to write the amicus brief for.
Organization of veterans advocates nova to write the amicus brief for the u. Va benefits 101 and cultural competency training course materials. Fill out the general release for medical provider information to the department of veteran affairs va online and print it out for free. If you are unable to find your form here, you may want to visit. Download fillable va form 214142a in pdf the latest version applicable for 2020. Download fillable va form 21 4142a in pdf the latest version applicable for 2020.
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