3. Requesting Evidence From Sources Other Than VA This topic contains information on requesting evidence from sources other Introduction than VA, including authorization required by private health care provider (PHP) and VA Forms 21-4142 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA) expiration of VA Forms 21-4142 development actions related to and VA Forms 21-4142 21-4142a general information about the Health Insurance Portability and Accountability Act (HIPAA) on the Veterans Benefits Administration (VBA) HIPAA’s impact covered entities under HIPAA request for buddy statements, and requests for medical records from SSA. June 10, 2015 Change Date a. Treatment received from private healthcare providers (PHPs) are often Authorization identified as relevant to a claim. The PHP who holds these records will not Required by a release the treatment records without a Health Insurance Portability and PHP Accountability Act (HIPAA) compliant authorization statement signed by the individual who is the subject of the information. When VAis attempting to secure the private medical records (PMR) on the the claimant should provide an authorization form that is claimant’s behalf, acceptable to the records holder by using the following VA Form 21-4142, General Release for Medical Provider Information to the and Department of Veterans Affairs (VA), VA Form 21-4142a, General Release for Medical Provider Information to or the Department of Veterans Affairs (VA), Special authorization form prescribed by the PHP. If and or other required PHP Note: VA Forms 21-4142 21-4142a authorization forms are of record, send a request to the claimant, not fiduciary, or next of kin, as appropriate. For more information on References: HIPAA privacy rule, see M21-1 Part III, Subpart iii, 1.C.3.e, and VA Forms 21-4142 and 21-4142a, see M21-1 Part III, Subpart iii, 1.C.3.b.
3. Requesting Evidence From Sources Other Than VA Introduction This topic contains information on requesting evidence from sources other than VA, including authorization required by private health care provider (PHP) VA Forms 21-4142 and 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs (VA) expiration of VA Forms 21-4142 development actions related to VA Forms 21-4142 and 21-4142a general information about the Health Insurance Portability and Accountability Act (HIPAA) HIPAA’s impact on the Veterans Benefits Administration (VBA) covered entities under HIPAA request for buddy statements, and requests for medical records from SSA. Change Date June 10, 2015 a. Authorization Required by a PHP Treatment received from private healthcare providers (PHPs) are often identified as relevant to a claim. The PHP who holds these records will not release the treatment records without a Health Insurance Portability and Accountability Act (HIPAA) compliant authorization statement signed by the individual who is the subject of the information. When VAis attempting to secure the private medical records (PMR) on the claimant’s behalf, the claimant should provide an authorization form that is acceptable to the records holder by using the following VA Form 21-4142, General Release for Medical Provider 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), or Special authorization form prescribed by the PHP. Note: If VA Forms 21-4142 and 21-4142a or other required PHP authorization forms are not of record, send a request to the claimant, fiduciary, or next of kin, as appropriate. References: For more information on HIPAA privacy rule, see M21-1 Part III, Subpart iii, 1.C.3.e, and VA Forms 21-4142 and 21-4142a, see M21-1 Part III, Subpart iii, 1.C.3.b.
9-24-15_Key%20Changes_M21-1III_iii_1_SecC.docx