VA Form 10-10172. COMMUNITY CARE PROVIDER - REQUEST FOR SERVICE. 2025

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The document is a 'Community Care Provider - Request for Service' form used by Veterans Affairs (VA) to request various medical services for veterans. It outlines the necessary information required for service requests, including veteran and provider details, requested services, and durable medical equipment specifications. The form emphasizes the need for supporting documentation and includes attestation statements regarding the accuracy of the information provided. It also specifies procedures for urgent care situations and the criteria under which services may be approved or referred to community providers.

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2021	4.8 Satisfied (46 Votes)
2019	4.3 Satisfied (261 Votes)

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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.

Does VA Community Care cover dental?

Some of the services offered include regular teeth cleaning, x-rays, fillings, crowns, bridges, dentures, and oral surgery. For more information on VA dental care services and how to file a claim, review the information below.

How do I request community care through the 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.

What is a VA statement of service letter?

A statement of service for VA loans is a formal letter used to provide concrete evidence of your military service, which is especially important when qualifying for a VA mortgage. Lenders typically use this letter to confirm your employment history and eligibility for a VA loan.

What is VA form 10 10172 used for?

To request additional services or extend authorization durations please use the Request for Additional Services (RFS) Form, VA Form 10-10172, which should be submitted to local facility community care staff using the office fax or email indicated on the referral form.

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What is a request for service form?

A request for service form is a fillable template that enables potential clients to detail their needs and requested services upfront.

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.

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.