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NOTE - PLEASE READ THE ENTIRE FORM (both pages) BEFORE SIGNING IN ITEM 11 BELOW - vba va

NOTE - PLEASE READ THE ENTIRE FORM (both pages) BEFORE SIGNING IN ITEM 11 BELOW - vba va 2026

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The document is a VA Form 21-4142, which serves as an authorization for veterans to disclose their medical records to the Department of Veterans Affairs (VA). It outlines the types of medical information that can be released, including treatment records related to various impairments. The form requires personal identification details from both the veteran and the medical providers, and it emphasizes the importance of consent for obtaining private treatment records. Additionally, it includes privacy notices and instructions regarding the use and expiration of the authorization.

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Click ‘Get Form’ to open it in the editor.
Begin with SECTION I, where you will authorize the release of your medical records. Ensure you check all relevant boxes that apply to your treatment history.
Proceed to SECTION II and fill in your personal identification details, including your last name, first name, middle name, date of birth, and Social Security number or VA file number.
In SECTION III, provide the patient identification for records being requested. This includes filling out the same personal details for the patient as required.
SECTION IV requires you to list all sources of medical records. Be thorough in identifying hospitals, clinics, and other providers who have treated you.
Finally, complete SECTION V by signing and dating the form. Make sure to review all entries for accuracy before submission.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can you get a home loan with 100% VA disability?

If youre a veteran with a disability rated 100%, you qualify for a VA home loan with valuable benefits.

What is the purpose of a VA certificate of eligibility?

Use VA Form 26-1880 to apply for a VA home loan Certificate of Eligibility (COE). Youll need to bring the COE to your lender to prove that you qualify for a VA home loan.

What is the VA form for the VA pension?

If you are making a claim for veterans non service-connected pension benefits, use VA Form 21P-527EZ, Application for Pension. If you are making a claim for survivor benefits, use VA Form 21P-534EZ, Application for DIC, Death Pension, and/or Accrued Benefits. VA forms are available at .va.gov/vaforms.

What is the VA request for certificate of eligibility form?

To request a COE by mail, fill out a Request for a Certificate of Eligibility (VA Form 26-1880) and mail it to the address for your regional loan center. You can find the address on the last page of the form. Please note that mail requests may take longer than requesting a COE online or through your lender.