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Get Va Hpm 589a4-359 2010-2025
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How to fill out the VA HPM 589A4-359 online
The VA HPM 589A4-359 form is designed for patients requesting a reassignment of their healthcare provider. This guide will help you navigate each section of the form to ensure that your request is submitted accurately and effectively.
Follow the steps to successfully fill out your reassignment request form.
- Press the ‘Get Form’ button to access the VA HPM 589A4-359 form and open it in your online editor.
- Begin filling out the form by providing your name clearly in the designated field. Ensure that you PRINT your name to avoid any confusion.
- Enter your social security number in the appropriate section. Make sure to double-check the number for accuracy.
- Indicate your current healthcare provider's name, either your physician or nurse practitioner, in the provided space.
- For the reason for your request, select the desired change in the location of your care. Choose between receiving care at a community clinic closer to home or at the Columbia VA hospital for its additional services.
- If seeking a different provider, explain your reasons in detail in the provided area. Be clear and specific to facilitate understanding.
- Sign the form in the designated signature field, and include the date of your signature. This step is crucial to validate your request.
- Once you have completed the form, choose to submit it either by giving it to clinic staff or mailing it to the Primary Care Service Line at the specified address.
- After submission, keep a copy for your records and await confirmation regarding your request.
Complete your VA HPM 589A4-359 form online today and take the next step in managing your healthcare!
You can find your VA file number in various documents related to your services with the Department of Veterans Affairs. Look for it in your benefits letters or claim statements. If you do not have these documents readily available, contacting the VA directly will provide you with this information. The VA HPM 589A4-359 might also assist you in locating this number.
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