Choice Program - Progress Summary 2026

1. Click ‘Get Form’ to open the Choice Program - Progress Summary in the editor.
2. Begin by entering the Veteran’s Name and DoD ID/Benefits # or Sponsor SSN in the designated fields at the top of the form.
3. Fill in the Date Completed and VA Auth Number to ensure accurate tracking of services.
4. Provide the Veteran’s Address, City, State, Zip, and Telephone number for contact purposes.
5. Indicate whether there is Other Insurance by selecting 'yes' or 'no', and specify if applicable.
6. Complete sections for Patient DOB, Service Branch, Provider Name, License Type, and Provider Contact Information including Telephone and Address.
7. Document any DSM-V Diagnosis and Co-Occurring Medical Conditions relevant to treatment.
8. Answer whether the patient has had a psychiatric hospitalization in the last 90 days by selecting 'yes' or 'no'.
9. List Dates of Service along with corresponding Service (CPT Code) and Service Description for each entry.
10. Summarize Treatment Progress and note any Treatment Plan Changes as necessary before signing.

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