Get Va 10-2649a 2019-2025
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How to fill out the VA 10-2649A online
Filling out the VA 10-2649A form is an essential step for facilitating patient transfers between healthcare facilities. This guide offers a straightforward and supportive approach to ensure that users can complete the form with confidence and accuracy.
Follow the steps to fill out the VA 10-2649A form effectively.
- Click ‘Get Form’ button to obtain the form and open it in the online editor.
- Enter the patient's demographic and eligibility information in Section I. This includes the veteran's last name, first name, middle initial, social security number, address, date of birth, and eligibility for VA care and travel/special mode.
- In Section II, specify the reason for the transfer by identifying the nature of services needed and providing a detailed description of the services required.
- Complete Section III by giving the diagnosis, description of treatment prior to the transfer, and the level of care before transfer, such as whether the patient was in the emergency room, outpatient, or intensive care unit.
- Fill out Section IV to assess the condition of the patient during the transfer, indicating whether they are medically and behaviorally stable.
- In Section V, describe the mode of transportation required for the patient, including any special staff requirements or IV medications needed during transport.
- Use Section VI to indicate the information that must accompany the patient, such as complete medical records and transfer notes.
- Ensure Section VII is completed by certifying that the benefits of the transfer outweigh the risks and that patient consent has been received if applicable.
- Document the names and contact information of responsible individuals in Section VIII, including the transferring and receiving physician details.
- Conclude by filling out Section IX regarding the decision of transfer and finalizing the form with necessary signatures.
- Once all sections are completed, save your changes, download, print, or share the form as required.
Start filling out the VA 10-2649A form online today and ensure a smooth transfer process.
Go to eBenefits to find a local representative (including a recognized VSO, an attorney, or a claims agent) by state/territory, zip code, or the organization's name. Or search the VA Office of the General Counsel's list to find VA-recognized organizations and VA-accredited individuals by name, city, state, or zip code.
Fill VA 10-2649A
Form name: InterFacility Transfer Form. Form revision date: April 2019. Q: What is the purpose of VA Form 10-2649A? A: The purpose of VA Form 10-2649A is to transfer a patient between VA medical facilities. VA Form 10-2649A, Interfacility Transfer Form: CPRS →New Note→ type in "Interfacility" → select. INTERFACILITY TRANSFER TEMPLATE (VA FORM 10-2649A) b.
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