The following information about this VA form comes from the VA forms database, and any changes are updated here nightly. Contact the form administration for further information.
Link to form
http://www.vba.va.gov/pubs/forms/VBA-21-4142-ARE.pdf
Form number
21-4142
Row ID
2428
Form title
Authorization to Disclose Information to the Department of Veterans Affairs(VA) (Fillable)
Issue date
Revision date
Form administration
VBA
Number of pages
5
Deleted
False
Form name
Authorization to Disclose Information to the Department of Veterans Affairs (VA)
Form Language
English
Related to
Benefits
VA disability compensation
VA health care
When to use

Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care. 

Helpful links
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File a Supplemental Claim
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