Dental report voucher veterans 2025

1. Click ‘Get Form’ to open the dental report voucher in the editor.
2. In the 'Patient details' section, enter the patient's DVA file number and full name. If the file number is unknown, include their address, date of birth, and phone number.
3. Fill in the 'Claimant details' with the provider's number, name, address, and telephone number. If a different practitioner provided services, include their name and indicate if they are a locum.
4. Complete the 'Record of Treatment' by entering the date of service, item number, tooth number, and amount claimed. Ensure that the patient signs next to each item listed.
5. Finally, have the claimant sign and date the declaration once treatment is completed or when submitting for payment.

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