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Direct Order Form - Department of Veterans Affairs

Direct Order Form - Department of Veterans Affairs 2026

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The document is a Direct Order Form for requesting mobility and functional support products through the Rehabilitation Appliances Program (RAP) for veterans and their dependents. It includes sections for provider details, entitled person information, hospital discharge details, and order specifics. The form emphasizes the need for clinical justification for prior approval items and outlines privacy protections under the Privacy Act 1988.

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Click ‘Get Form’ to open the Direct Order Form in the editor.
Begin by filling out the Provider Details section. Enter your name, provider number, employer, and contact information including phone and email.
Next, complete the Entitled Person/Delivery Details. Input the surname, given names, date of birth, DVA file number, and card type. Indicate if the entitled person resides in a Residential Aged Care Facility.
If applicable, provide Hospital Discharge Details by specifying if an item is required for discharge and entering the discharge date.
In the Order Details section, refer to the RAP Schedule of Equipment for product specifications. Fill in the product catalogue number, size, type, specifications, and quantity needed.
Finally, certify that you have clinically assessed the client by signing and dating at the bottom of the form.

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Versions	Form popularity	Fillable & printable
2022	4.3 Satisfied (52 Votes)
2016	4 Satisfied (47 Votes)

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What is VA form 2237 used for?

What form is used when turning in excess furniture or equipment? Excess is processed via VA Form 2237 (Request, Turn-In and Receipt for Property or Services) which can be found on VA Forms.

What form do I need to set up direct deposit with the VA?

To set up direct deposit in person, go to your nearest VA regional office. Note: If you dont have access to the internet or a phone, you can update your direct deposit information with the Direct Deposit Sign-Up Form (VA Form SF-1199a).

What is VA form 10091?

VA Form 10091 is used to gather essential payment data from vendors (Commercial, Individuals, Veterans, etc.) to establish or update vendor records in order to process electronic payments in accordance with Title 31 of the Code of Federal Regulation Part 208 (31 CFR Part 208).

How to set up direct deposit for VA benefits?

Step-by-step instructions Sign in to VA.gov with your verified Login.gov or ID.me account. To change direct deposit information, you must verify your identity. Go to your VA.gov profile. Go to direct deposit information. Edit your direct deposit information. Enter and save your changes.

What is a VA form 6789?

prepares VA Form 21-6789, to document the determination that no additional development is required under 38 CFR 3.159(d)

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