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  • REQUEST FOR SERVICES (RFS) FORM - Veterans Affairs

    va.gov

    https://www.va.gov/vaforms/medical/pdf/VA_Form_10-10172.pdf

    WEBNOTE: The Request for Services (RFS) Form 10-10172 must be submitted via an approved method (HSRM, Electronic fax, Direct Messaging, traditional fax, or mail). Completion of this form is REQUIRED and MUST BE SIGNED by the requesting provider for further care to be rendered to a Veteran patient.

    DA: 15 PA: 53 MOZ Rank: 21

  • About VA Form 10-10172 | Veterans Affairs

    va.gov

    https://www.va.gov/find-forms/about-form-10-10172/

    WEBSep 30, 2023 · About VA Form 10-10172. Form name: Community Care Provider—Request for Service. Related to: VHA. Form last updated: September 2023. Downloadable PDF. Download VA Form 10-10172 (PDF) Helpful links. Find out how to update your direct deposit information online for disability compensation, pension, or education benefits.

    DA: 34 PA: 22 MOZ Rank: 35

  • Request and Coordinate Care - Community Care - Veterans Affairs

    va.gov

    https://www.va.gov/COMMUNITYCARE/providers/Care-Coordination.asp

    WEBA blank RFS Form will be sent with all referral packets and is also available online. To complete VA Form 10-10172, fill-out the required fields and indicate the type of service being requested. Please note: A separate form is required for each service requested.

    DA: 67 PA: 48 MOZ Rank: 3

  • Provider Resources & Reference Library - Community Care - Veterans Affairs

    va.gov

    https://www.va.gov/COMMUNITYCARE/providers/reference.asp

    WEBMar 11, 2024 · Fillable PDF forms for community providers; Item Title / Description Associated Page / Website; Community Care Provider Request for Service (RFS), VA Form 10-10172 : Request and Coordinate Care–Request for Service (RFS) Requirements : FMP Claim Cover Sheet, VA Form 10-7959f-2 : Other Types of Care–FMP : HSRM End User Tracker Template (Excel ...

    DA: 10 PA: 63 MOZ Rank: 18

  • VA.gov | Veterans Affairs

    va.gov

    https://www.va.gov/COMMUNITYCARE/providers/Service-Requirements.asp

    WEBApr 4, 2024 · To request routine DME, prosthetics or orthotics for a Veteran, complete VA Form 10-10172, Request for Services (RFS), and return it to the local VA facility community care office. Page 2 of the form is dedicated to these specific requests.

    DA: 25 PA: 4 MOZ Rank: 8