Home
Forms Library
Va secondary authorization request

Get the up-to-date va secondary authorization request form 2025 now

va secondary authorization request Preview on Page 1

Show details

4 out of 5

45 votes

The document is a Secondary Authorization Request form for the Veterans Choice Program by TriWest Healthcare Alliance. It collects essential information about the veteran, including personal details, provider information, treatment progress, and risk assessments related to suicidal or homicidal behavior. The form also includes sections for updating treatment plans and requesting authorization for various psychotherapy services.

Here's how it works

01. Edit your va secondary authorization request online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send secondary authorization request va via email, link, or fax. You can also download it, export it or print it out.

The fastest way to redact Va secondary authorization request form online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is the best editor for updating your forms online. Adhere to this straightforward guide to redact Va secondary authorization request form in PDF format online at no cost:

Sign up and sign in. Register for a free account, set a strong password, and go through email verification to start managing your forms.
Upload a document. Click on New Document and select the file importing option: add Va secondary authorization request form from your device, the cloud, or a secure URL.
Make adjustments to the template. Take advantage of the upper and left panel tools to redact Va secondary authorization request form. Insert and customize text, images, and fillable fields, whiteout unneeded details, highlight the significant ones, and provide comments on your updates.
Get your documentation completed. Send the form to other parties via email, create a link for quicker file sharing, export the template to the cloud, or save it on your device in the current version or with Audit Trail included.

Explore all the benefits of our editor today!

be ready to get more

Complete this form in 5 minutes or less

Get form

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.

What VA form is used for secondary claims?

Use VA Form 21-526EZ when you want to apply for VA disability compensation (pay) and related benefits.

What VA form do you use for secondary conditions?

Complete VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs (VA) and VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA); submit completed forms with your claim and VA will attempt to obtain your records through our

What is the difference between VA form 21 4142 and VA form 21-4142a?

What form is used when turning in excess furniture or equipment? Excess is processed via VA Form 2237 (Request, Turn-In and Receipt for Property or Services) which can be found on VA Forms.

What is the VA form 21 526b used for?

VA Form 21-526 and 21-526b are used to gather the necessary information to determine a veterans eligibility, dependency, and income, as applicable, for the compensation and/or pension benefit sought. Claimants who need assistance in obtaining non-VA medical records complete VA Form 21-4142.

What is a VA form 2237 used for?

Community Care Provider-Request for Service (RFS), VA Form 10-10172, is used to request additional services or continued care from VA. The requested care may be performed within VA or in the community based on a Veterans eligibility. The signed RFS is required to facilitate care review and authorization.

va secondary authorization request form

va form 10-10172 VA prior authorization request form VA Request for services form Fax number VA authorization form for Providers VA referrals and authorizations VA RFS form PDF va form 10-10172 pdf VA prior authorization form for medication

How do I claim secondary conditions in VA?

Youll need to download and fill out a Decision Review Request: Supplemental Claim (VA Form 20-0995). If you want us to get medical records and information from your private health care provider, youll also need to fill out VA Form 21-4142. You can submit this form online. Or you can download it and submit by mail.