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va form 21 4142 fillable
va form 21 4142 fillable

Fillable AUTHORIZATION AND CONSENT TO RELEASE INFORMATION TO ... - vba va

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Benefits. va.gov/compensation/consentprivateproviders. asp. VA FORM 21-4142 JUN 2014 PAGE 2 GENERAL RELEASE FOR MEDICAL PROVIDER INFORMATION TO THE DEPARTMENT OF VETERANS AFFAIRS VA INSTRUCTIONS - COMPLETE AND ATTACH THIS FORM WITH A SIGNED VA FORM 21-4142 AUTHORIZATION TO DISCLOSE INFORMATION TO THE DEPARTMENT OF VETERANS AFFAIRS VA. L. 104-191 HIPAA 45 C. F.R. parts 160 and 164 42 U.S.C. 290dd-2 42 C. F.R. part...
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