Home
Forms Library
Request for service form va

VA Form 10-10172. Community Care Provider - Request for Service 2025

request for service form va Preview on Page 1

Show details

4.3 out of 5

261 votes

The document is a request form for community care services for veterans, detailing the necessary information required for service authorization, including veteran and provider details, requested services, and medical justification. It emphasizes that requests are subject to approval by the VA Medical Center and outlines the process for urgent care needs.

Here's how it works

01. Edit your request for service form va online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send va form 10 10172 via email, link, or fax. You can also download it, export it or print it out.

How to edit VA Form 10-10172. Community Care Provider - Request for Service in PDF format online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Working on documents with our comprehensive and user-friendly PDF editor is straightforward. Follow the instructions below to fill out VA Form 10-10172. Community Care Provider - Request for Service online easily and quickly:

Log in to your account. Sign up with your credentials or create a free account to try the service before choosing the subscription.
Upload a document. Drag and drop the file from your device or import it from other services, like Google Drive, OneDrive, Dropbox, or an external link.
Edit VA Form 10-10172. Community Care Provider - Request for Service. Easily add and highlight text, insert pictures, checkmarks, and symbols, drop new fillable areas, and rearrange or delete pages from your paperwork.
Get the VA Form 10-10172. Community Care Provider - Request for Service completed. Download your updated document, export it to the cloud, print it from the editor, or share it with other people through a Shareable link or as an email attachment.

Make the most of DocHub, the most straightforward editor to promptly handle your paperwork online!

See more VA Form 10-10172. Community Care Provider - Request for Service versions

We've got more versions of the VA Form 10-10172. Community Care Provider - Request for Service form. Select the right VA Form 10-10172. Community Care Provider - Request for Service version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (46 Votes)
2019	4.3 Satisfied (261 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How much does the VA pay for home care?

Home health aide services run an average of $4,385 per month in Stockton, California, but that figure rises to $5,720 per month in San Francisco.

What is a VA 10 10172 request for service?

Community Care Provider-Request for Service (RFS), VA Form 10-10172, is used to request additional services or continued care from VA. The requested care may be performed within VA or in the community based on a Veterans eligibility. The signed RFS is required to facilitate care review and authorization.

How do I switch to community care in VA?

Get a referral from your VA health care team. Ask your VA health care team for a referral to the community provider. Well review your request to make sure youre eligible. Then well contact you to confirm that you want to get community care and the type of appointment you need. Well then prepare your referral.

How to fill out a VA Form 10210?

You should include the following information: The Veterans first name, last name, and middle initial. The Veterans Social Security number. The Veterans VA file number, if any exists. The Veterans date of birth. The Veterans VA insurance file, if applicable.

How to get community care through VA?

Depending on the type of care a Veteran needs, a VA staff member will work with the Veteran to determine which options are available. a community care consult has been approved and a referral is sent to the selected provider, Veterans can directly contact a community provider in VAs network to schedule an appointment.

va10 10172

va form 10-10172 pdf Community care Provider Request for Service form VA Request for services form Fax number va form 10-10172 fillable where to fax va form 10-10172 va form 10-10172 may 2021 VA referrals and authorizations VA RFS form PDF

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

Who is eligible for the VA community living center?

You must first be enrolled in the VA health system and be medically and psychiatrically stable. A copay may be charged for CLC care based on your VA service- connected disability status and financial information.

VA Form 10-10172. Community Care Provider - Request for Service 2025

Here's how it works

How to edit VA Form 10-10172. Community Care Provider - Request for Service in PDF format online

See more VA Form 10-10172. Community Care Provider - Request for Service versions

Complete this form in 5 minutes or less

Got questions?

How much does the VA pay for home care?

What is a VA 10 10172 request for service?

How do I switch to community care in VA?

How to fill out a VA Form 10210?

How to get community care through VA?

Complete this form in 5 minutes or less

People also ask

Who is eligible for the VA community living center?

rfs form

Try more PDF tools