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All About Forms: The Authorization and Consent to Release Information

What exactly are you agreeing to when you sign the Authorization and Consent to Release Information to the Department of Veterans Affairs (VA Form 21-4142)?

This form gives the VA consent to request and receive copies of your medical records from the health care providers you list on the forms. This includes X-rays, lab reports, results of procedures and other pertinent information.

Please note: A separate form should be sent to each provider.

For the most up-to-date version of this form, go online to www.va.gov/vaforms/ or contact your local Department of Veterans Affairs office. As mentioned above, the form number is 21-4142.


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