VA Form 10-2850A: Online Application for NursesPDF 2025

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The document is an application form (VA Form 10-2850a) for nurses and nurse anesthetists seeking appointment in the Veterans Health Administration. It collects personal information, professional qualifications, and details regarding nursing registration and clinical privileges. The form also includes sections for certification by facility directors, professional liability insurance, nursing experience, references, and a release of information authorization. Additionally, it outlines the legal implications of providing false information and includes notices related to privacy and the Paperwork Reduction Act.

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Versions	Form popularity	Fillable & printable
2023	4.3 Satisfied (43 Votes)
2016	4.8 Satisfied (132 Votes)
2006	4.3 Satisfied (115 Votes)
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What is a VA form 10 2850A?

APPLICATION FOR NURSES AND NURSE ANESTHETISTS.

What is the purpose of VA form 10 5345?

Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization.

Do I need a VA form 10 2850c?

Who needs VA 10-2850c? The VA Form 10-2850c is required for healthcare professionals applying for employment at the Veterans Affairs health facilities. It is needed by individuals seeking to establish qualifications for specific healthcare positions.

Where do I send a VA apportionment form?

After completing the form, mail to: Department of Veterans Affairs, Evidence Intake Center, P.O. Box 4444, Janesville, WI 53547-4444.

How to submit VA form 10 5345?

Youll need to fill out an Individuals Request for a Copy of Their Own Health Information (VA Form 10-5345a). Submit your completed form to your VA health facilitys medical records office. This office is also called a Release of Information Office. You can submit your form by mail, by fax, or in person.