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VA Form 21-4142a

ICR 202404-2900-008 · OMB 2900-0858 · Object 142154701.

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File Typeapplication/octet-stream
File TitleVA Form 21-4142a
SubjectGENERAL RELEASE FOR MEDICAL PROVIDER INFORMATION 
TO THE DEPARTMENT OF VETERANS AFFAIRS (V. A.)
File Modified2024-04-25
File Created2023-04-20
Conversion Statecomplete