Form 4718a is not the form you're looking for? Search for another form here.
Video instructions and help with filling out and completing va form 21 4718a
Laws dot-com legal forms guide a VA Form 21 - 41 42 is a United States Department of Veteran Affairs form used to authorize and provide consent for the release of medical information to the VA this form must be on file before Veterans Affairs can review any medical or disability claims the VA Form 21 - 41 42 is available on the Veterans Affairs documentation website or can be supplied through a local Veterans Affairs office the first section is used for general identification information boxes 1 2 & 4 are to be filled out with the veterans name file number and social security number these boxes must be filled in if a claimant other than the veteran is seeking benefits on behalf of the veteran they must provide their name relationship and social security number in boxes 3 5 & 6 in section 2 you must identify all sources of medical information for which you are allowing Veterans Affairs to have you must include the name and addresses for all offices for which your medical or disability claim involves you must also include the dates and conditions or illnesses for which you were treated inbox aid provide any additional comments about your consent that will be helpful for Veterans Affairs to seek your medical history and to view them section 3 provides all of the important privacy information that the Department of Veterans Affairs will be held read all of the information and check the authorization box in box 9 see in box 10 the veteran the claimant or a legal representative must certify with their signature their consent of the VA form 21 - 41 42 provide your contact information including address and phone numbers this is important as Veterans Affairs may need to contact you in regards to this form and to further obtain your consent for additional information they need for processing your claims in box 11 it is important that you have a witness sign and date the form while this is not necessary for all medical records Veterans Affairs may need a witness statement when seeking some of your records once completed your VA Form 21 - 41 42 is ready for submission to Veterans Affairs keep a copy on record as you may need to submit a additional consent forms if you make additional claims to watch more videos please make sure to visit laws dot-com
