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How to fill out the VA 21-0960Q-1 online
The VA 21-0960Q-1 is a form used to evaluate chronic fatigue syndrome in veterans seeking disability benefits. Completing this form accurately is essential for a thorough assessment by the Department of Veterans Affairs.
Follow the steps to fill out the VA 21-0960Q-1 form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering the name of the patient or veteran in the appropriate field, as well as their social security number.
- In Section I, Diagnosis, indicate whether the veteran has been diagnosed with chronic fatigue syndrome by selecting 'Yes' or 'No.' If 'Yes,' provide details for Item 1B, selecting the veteran's condition and entering diagnostic codes and dates.
- Proceed to Section II, Medical Record Review, where you must indicate which medical records you reviewed when preparing the report.
- In Section III, Medical History, summarize the veteran’s history of chronic fatigue syndrome in Item 3A, specify if medication is required for control in Item 3B, and confirm whether other conditions have been excluded per Items 3C and 3D.
- Move to Section IV, Findings, Signs and Symptoms. Here, you will specify if there are any symptoms attributable to chronic fatigue syndrome and provide descriptions for each condition.
- Continue in Section V, where you will indicate any relevant physical findings or complications related to the condition.
- In Section VI, Diagnostic Testing, summarize any significant findings from diagnostic tests performed.
- Proceed to Section VII, where you will detail the impact of chronic fatigue syndrome on the veteran's ability to work.
- In Section VIII, provide any additional remarks that may be pertinent.
- Finalize the form by completing Section IX with the physician's certification, including their signature, printed name, contact information, license number, and date signed.
- Once completed, you can save changes, download, print, or share the form for submission.
Complete the VA 21-0960Q-1 online to ensure a smooth claims process.
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