Get Va Form 10-2649a, Interfacility Tranfer Form - Va

Filling out the VA Form 10-2649A is an essential process for ensuring the effective transfer of patients between facilities. This guide will provide you with step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to download the form and open it in your chosen editor.
2. Begin by filling out Section I, Demographic and Eligibility Information. Include the veteran's last name, first name, middle initial, date of birth, and social security number. Ensure you enter the address and document eligibility for VA care and travel/special mode.
3. For Section II, Reason for Transfer, describe the nature of services needed by the patient and state the reason for transfer, such as consultation/evaluation or a lack of available beds.
4. In Section III, Type and Level of Services Required, provide the patient's diagnosis, the description of treatment prior to transfer, and any further treatment that is contemplated, including the level of care prior to transfer.
5. Complete Section IV, Condition of Patient on Transfer, by indicating whether the patient is medically and behaviorally stable for transfer. Provide detailed descriptions of their vital signs and any other relevant medical information.
6. In Section V, Mode of Transportation, describe any special modes of transport and the staff requirements necessary for the transfer, along with IV medications or other treatments to be administered en route.
7. Section VI requires you to indicate all information that must be sent with the patient, including medical records, discharge summaries, and any imaging studies.
8. For Section VII, ensure patient/family consent is documented. The transferring physician should certify that the benefits of the transfer outweigh the risks and sign the form.
9. Fill out Section VIII with the names and contact information for the transferring and receiving physicians, including the facility names.
10. Lastly, complete Section IX, Decision, to indicate whether the transfer request was accepted or not, and provide the necessary details as required.
11. Once all sections are thoroughly filled out, review the form for accuracy, then save your changes, download, print, or share the completed form as needed.

Begin the process of filling out the VA Form 10-2649A online to facilitate patient transfers effectively.