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INSTRUCTIONSCOMPLETE AND ATTACH THIS INSTRUCTIONSComplete and attach this form with a signed VA Form, Authorization To Disclose Information To The Department Of Veterans Affairs (VA). Submit a lay
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VA Form 21-4142a is a form used by veterans and claimants to authorize the release of medical records from their healthcare providers to the Department of Veterans Affairs (VA) for the purpose of processing benefits claims.
Any veteran or claimant who is seeking VA benefits and needs to provide medical evidence from healthcare providers must file VA Form 21-4142a.
To fill out VA Form 21-4142a, provide your personal information, including your name, Social Security number, and the details of the healthcare provider. Then, sign and date the form to authorize the release of information.
The purpose of VA Form 21-4142a is to obtain consent from the claimant to allow the VA to access relevant medical records from healthcare providers to support the claim for VA benefits.
The form requires the claimant's personal information, the name and contact details of the healthcare provider, and the specific types of records requested.
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