VA Form 21-4142 and its companion form 21-4142a are the authorization forms that allow the VA to request your medical records from private (non-VA) healthcare providers. Getting these forms right is important because errors can delay your claim by weeks or months.
VA Form 21-4142 is the primary authorization. It includes your personal information, the name and address of the medical provider, the dates of treatment you want the VA to request records for, and your signature authorizing the release.
VA Form 21-4142a is a supplemental general release that some providers require in addition to the 21-4142. It provides broader authorization language that satisfies HIPAA requirements. Both forms should be submitted together for each provider.
When completing the forms, include the provider full legal name as it appears on their letterhead, complete street address including suite numbers, phone and fax numbers if available, and the date range of treatment. If you are unsure of exact dates, provide your best estimate and note that dates are approximate. It is better to cast a wider net than to miss relevant records.
You need a separate set of forms for each provider. If you saw a primary care doctor, an orthopedist, and a psychologist, that is three sets of forms. If you were treated at the same provider at different locations, you may need separate forms for each location.
The authorization is valid for 180 days from the date you sign it. If the VA has not obtained the records within that window, you may need to resubmit. Check your claim status periodically to see whether records have been received.
Common errors that cause delays include illegible handwriting, missing the provider address, forgetting to sign the form, providing dates of treatment that are too narrow (causing the provider to send incomplete records), and submitting only one form when both 21-4142 and 21-4142a are needed.
You can submit these forms online through VA.gov, by mail to your regional office, or through your VSO representative. Electronic submission is generally faster and creates an automatic receipt record.
Note: This article references sections of the VA's M21-1 Adjudication Procedures Manual. The VA periodically reorganizes the M21-1 and section numbers may have changed since this article was written. For the most current section references, visit the VA's public M21-1 Web Automated Reference Material System (WARMS).