Get Va Form 10 0114r

The Va Form 10 0114r is a vital document for requesting community nursing home authorization through the Veterans Administration. This guide provides a comprehensive walkthrough for completing this form accurately and efficiently online, ensuring you have the necessary information to support your needs.

Follow the steps to fill out the Va Form 10 0114r effectively.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Begin by filling in the 'TO' section, where you will input the fax number designated for this request.
3. In the 'FROM' section, provide your name, telephone number, and details about your position or role related to the referral.
4. Next, specify the subject of your transmission—here, it will specifically be a 'Request for Community Nursing Home Authorization.'
5. Under the 'information required' section, list all necessary documents that support the CNH referral, such as the State of Florida PASRR and medical documentation.
6. Detail any specialty care needs the veteran may require by filling in the provided fields for oxygen, tube feedings, wound care, and more.
7. Identify the contract nursing facility that will accept the veteran by typing its name in the designated field.
8. Finally, include a point of contact with phone number from the referring source for follow-up on the status of the referral.
9. Once all required fields are complete, save any changes made, and you can download, print, or share the completed form as needed.

Complete your Va Form 10 0114r online today to ensure timely processing of your authorization request.