Follow the steps to fill out the VA 21 0960J 4 online

1. Press the ‘Get Form’ button to access the form and open it in your browser.
2. Enter the name of the patient or veteran in the designated field. Make sure the spelling is correct.
3. Provide the patient or veteran's social security number in the appropriate section.
4. In Section I - Diagnosis, indicate if the veteran currently has or has ever been diagnosed with a condition of the bladder or urethra by selecting 'Yes' or 'No'. If 'Yes' is selected, complete Item 1B by listing relevant diagnoses, ICD codes, and dates of diagnosis.
5. In Section II - Medical Record Review, specify the medical records that were reviewed in preparation of the report. Indicate if it includes a C-file or other records.
6. Proceed to Section III - Medical History and provide a brief summary describing the history of the urinary tract condition.
7. For Section IV - Voiding Dysfunction, answer whether the veteran has a voiding dysfunction. If 'Yes', complete Items 4A through 4E detailing the condition’s etiology, symptoms, and any necessary appliances.
8. Continue to answer questions in subsequent sections including conditions related to urolithiasis, bladder infections, and other pertinent findings as applicable.
9. In Section XI - Functional Impact, describe how the condition impacts the veteran's ability to work, providing specific examples.
10. Finally, complete Section XIII with the physician's certification including all necessary details like the signature, printed name, phone number, medical license number, and date signed.
11. Once the form is filled out, save your changes and proceed to download, print, or share the completed document as necessary.

Complete the VA 21 0960J 4 online today to ensure you receive the benefits to which you are entitled.