Question on the release of medical provider forms

Discussion in 'Veteran Application' started by csa, Feb 26, 2017.

  1. csa

    csa Newbie

    I am slowly getting there!! I was wondering exactly what the VA is after on the medical provider form 21-4142a. The family doctor,the hospital and cardiologist my 98 y/o grandfather uses I have entered but the dates of treatment would be quite lengthy, is the provider info enough or do they need exact dates for every visit?
  2. Kaylin

    Kaylin Hero Member Staff Member

    I'm not sure you would need this form to complete the Aid and Attendance application. What exactly are you filing for, csa?
  3. csa

    csa Newbie

    He is filing for the Aid and Attendance pension,with me doing the leg work. My grandfather moved into an assisted living facility a month ago.He's still sharp of mind just the body doesn't cooperate and needs help bathing, dressing and meal preparation. It is private pay only so we are trying to keep him there as long as he can. I printed off the forms recommended by "A Place for Mom"21-4142 was one listed. I guess I need to know which forms are required for him to apply. I am grateful for all your help.
    Kaylin likes this.
  4. Kaylin

    Kaylin Hero Member Staff Member

    Okay, good! Just wanted to double check. On this page of our site you will find the list of required forms. Some are optional based on his situation. But basically you will need to fill out the 21-527EZ, discharge papers, Physician's statement 21-2680, Authorization to Disclose Personal Info to Third party form 21-0845, Nursing Home Status Statement, and a Statement of Occupancy (ask the facility for this one). Those are the must-haves for your father's situation. The How to Apply page lists the other forms if you need them or want to include additional evidence.
  5. csa

    csa Newbie

    Thank You !!! This forum has been a lifesaver !! Thanks again
    Kaylin likes this.
  6. Kaylin

    Kaylin Hero Member Staff Member

    You're welcome!
  7. Jandy

    Jandy Jr. Member

    hi csa,
    Just an anecdotal answer here--I did not include Form 21-4142a in my veteran father's application for A&A. There was no problem and I was never asked for it.

    As far as supporting medical forms, I included a Physician Statement (Form 21-2680) with specific info from his doctor . I included a statement from his ALF stating he is a resident there and what he needs assistance with. And I did include a Medical Expense Report (VA Form 21P-8416) since that was on the list of required documents on the page Kaylin linked to above. But I wasn't rigorously precise (with dates, etc); in fact, I marked through one section that asks for miles traveled for medical purposes, stating we weren't claiming these costs as an unreimbursed medical expense. Again, the application went through with no questions on his medical care and expenses.

    Please note my father's situation might be different than your grandfather's. My father has dementia and lives in memory care at an ALF, but other than his dementia issues, he doesn't have a lot of medical problems--there just wasn't that much to share on the Med Expense Report.

    Good luck!
    Kaylin likes this.

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