Dec 18, 2025 · 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 …

Although the information we obtain with this form is almost never used for any purpose other than those stated above, the information may be disclosed by VA without your consent if authorized …

Apr 4, 2023 · By signing Form 21-4142, you allow the VA to obtain information regarding your medical history and any treatments received. You are usually charged when requesting …

Feb 21, 2025 · This form allows the VA to request medical records, treatment notes, and diagnostic tests from non-VA providers. Veterans must complete one form per healthcare …

The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975 …

The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to January 1, 1975, …

Mar 15, 2023 · The Department of Veterans Affairs (VA) Form 21-4142, Authorization to Disclose Information to VA, gives VA permission to obtain a veteran’s medical treatment records from …

Records - VA, published in the Federal Register. Your obligation to respond is voluntary. However, if the information including your Social Security Number (SSN) is not furnished …