Get Veterans Care Coordination Referral Form

This guide provides step-by-step instructions for completing the Veterans Care Coordination Referral Form online. By following these clear directions, you can ensure that all necessary information is filled out accurately to facilitate the support needed for veterans and their families.

Follow the steps to complete the form accurately and efficiently.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editing tool.
2. Identify the client type by selecting one option: Surviving Spouse, Veteran, or Couple. Ensure you check the applicable box for your situation.
3. Answer question 1 regarding the veteran's discharge status by selecting 'Yes' or 'No.' This information is essential for eligibility.
4. For question 2, confirm if the veteran served at least 90 consecutive days of active duty during the specified wartime periods by selecting 'Yes' or 'No.' Circle the relevant wartime period if applicable.
5. If you are the surviving spouse, answer question 3 about your marital status at the time of the veteran's death by selecting 'Yes' or 'No.'
6. For question 4, indicate whether you have remained unmarried after the veteran's passing by selecting 'Yes' or 'No.'
7. Address question 5 regarding the need for assistance with Activities of Daily Living by selecting 'Yes' or 'No.' Remember to review the listed activities for any that apply.
8. Question 6 requires you to assess your assets. Confirm whether they are less than $80K, and circle any applicable ranges. Answer 'Yes' or 'No' based on your financial situation.
9. If all answers to questions 1 to 6 are 'Yes' or 'N/A', continue to question 7 and specify if the client currently receives services from your organization by selecting 'Yes' or 'No.'
10. For question 8, state whether assisted living or nursing home care is being considered within the next 60-90 days by selecting 'Yes' or 'No.'
11. Finally, respond to question 9 regarding whether the veteran or surviving spouse is already receiving VA money by selecting 'Yes' or 'No.'
12. Complete the contact information section, providing details such as referring organization, contact information, client name, and relationship to client.
13. Once all sections are accurately filled out, review the form for any errors. You can save changes, download, print, or share the completed form as needed.

Complete your Veterans Care Coordination Referral Form online today for better support.