VA Form 21-4142a, General Release For Medical Provider Information to the Department of Veterans Affairs, is a form used for gathering private provider information about a Veteran's private providers for the Department of Veterans Affairs (VA). The release is submitted along with the following paperwork:
The VA 21-4142a is distributed as part of the main VA Form 21-4142 or can be downloaded and filed separately.
The latest version of the form was released by the VA in March 2018. A fillable VA Form 21-4142a is available for digital filing and download below or can be found on the VA Forms website.