VA Form 21-4142
Authorization to Release Medical Records
Gives the VA permission to pull your private doctor's records. Saves you from gathering them yourself.
Authorization to Release Medical Records
In Plain English
Gives the VA permission to pull your private doctor's records. Saves you from gathering them yourself.
Authorizes the VA to request medical records from private healthcare providers on your behalf.
Step-by-Step Guide
How to file 21-4142
When to use this form
When you have private (non-VA) medical records that support your claim. Instead of gathering records yourself, this form lets the VA request them directly from your doctors.
Required
- ✓List of healthcare providers with addresses
Name, full address, and phone number for each provider.
- ✓Dates of treatment
Approximate dates are acceptable if you don't remember exact dates.
You'll need to provide
- ✓Name and address of each private healthcare provider
- ✓Dates of treatment at each facility
- ✓Conditions treated at each provider
- ✓Your signature authorizing the release
- ✕Forgetting to list all providers — include every doctor, hospital, or clinic that treated your claimed conditions
- ✕Not including complete addresses for providers
- ✕Submitting without signing — the authorization requires your signature
- ✕Not filing one at all — many veterans don't know the VA can pull records for them
Mail to
Department of Veterans Affairs, Claims Intake Center, PO Box 4444, Janesville, WI 53547-4444
Submit with your 21-526EZ or as additional evidence for a pending claim.
Pro Tip
You don't have to chase down your own medical records. File this form and let the VA do the work. Include every provider who has records related to your claimed conditions.
Which Form Do I Need?
21-4142 vs. 21-4142a — do I need both?
Authorization to Release Medical Records
Use this when
- •Use this to authorize the VA to contact each private provider
- •This is the primary form — most veterans only need this one
General Release for Medical Records
Use this when
- •Only needed when you have more providers than 21-4142 has space for
- •This is a continuation sheet, not a standalone form
Our recommendation
Most veterans only need 21-4142. If you have more than four private providers to list, also submit 21-4142a as a continuation sheet.
Related Forms
You might also need
General Release for Medical Records
Companion form to 21-4142. Lists additional healthcare providers.
Disability Compensation Claim
THE claim form. This is how you officially apply for disability benefits.
Lay/Witness Statement (Buddy Statement)
A written statement from someone backing up your claim — friends, family, or fellow service members.
Continue Your Research
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