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Click ‘Get Form’ to open VA Form 2142 in the editor.
Begin with Section I, where you will enter the patient identification details. Fill in the veteran's last name, first name, middle name, Social Security number, and VA file number.
Proceed to Section II for medical provider information. Start by entering the provider or facility name in field 4A. Then, specify the dates of treatment in fields 4B and provide the street address, city, state, and ZIP code in fields 4C to 4E.
If there are additional providers, repeat step 3 for fields 5A to 5E and again for fields 6A to 6E as needed. Ensure all telephone numbers are included in fields ending with 'F'.
Review all entered information for accuracy before saving your changes. Utilize our platform’s features to sign and distribute the completed form easily.
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DA Form 2142 is an Army Pay Inquiry form used by active duty soldiers to report issues or ask questions regarding their military pay. If a soldier believes theres a mistake with their military paycheck, this form allows them to initiate an inquiry.
What is VA form 21-4142 used for?
Use VA Form 21-4142 to give us permission to obtain your personal information from a non-VA source like a private doctor or hospital. Examples of personal information may include your medical treatment, hospitalizations, psychotherapy, or outpatient care.
What is a VA form 21-4142 used for?
VA Form 0242 Governmentwide Purchase Card Certification Form is used to delegate authority to an individual to use the purchase card to procure and pay for goods and services.
What is the difference between VA Form 21-4142 and VA Form 21 4142a?
The VA Form 21-4142 is generally valid for 12 months from the date signed. The VA Form 21-4142 clearly states at the heading EXPIRES that the authorization is good for 12 months from the date signed.
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Forms | Military and Veteran Success Center | CSU Pueblo
VA Education Benefits Checklist: This checklist will guide new students though the process of gaining acceptance to Colorado State University-Pueblo as well
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