Va 21-4142a Form 2021-2025

Va 21-4142a Form: What You Should Know

This form  can be obtained from any Department of Veterans Affairs health care provider, licensed or not, who provides health care to veterans. AUTHORIZATION TO DISCLOSE INFORMATION TO THE VA(VA Form 21-4142a) SCHOOL OF MEDICINE — FALLS CHURCH, P.O. CONSIDERATION OF APPLICATION: FIND THE AVAILABILITY OF MORE DETAILS ABOUT THE FOLLOWING MENTIONED INFORMATION BELOW.   1. If the health care provider is not a hospital, the name of a licensed physician who is in agreement with the statement contained on  this certification form. If the health care provider is not a hospital, the name of a licensed physician who is in agreement with the statement contained on this certification form.  2. The name of a licensed hospital, licensed physician, or other health care provider, that provides services to veterans. 3. Any health care provider who provides health care to veterans through a network health care plan. NOTE: An application is not automatically approved by contacting the health care provider. AUTHORIZATION TO DISCLOSE INFORMATION TO THE VA (VA Form 21  Authorization to Disclose Information To The VA (VA Form 21-4142a)  CERTIFICATION TO THE DOCTOR CERTIFICATE OF LICENSE (CLR) HILLSIDE MEDICINE COUNCIL FOR MILITARY SERVICEWOMEN SENT IN PRIOR AWARENESS PROGRAM The Hillside Medical Society (HMS) is a nonprofit, charitable organization dedicated to the provision of excellent quality health care to military women stationed as nurses or physicians at the Department of Veterans Affairs medical centers in San Diego and El CENTR, California.  It provides an array of assistance to both active duty and Reserve medical officers and medical technicians, providing training and professional guidance for female doctors and nurses.  To read more about the program's success, click here.  If you need help, please contact Holly Jones, Executive Director at, email or call toll-free.

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