VA Form 10-10172 Community Care Provider - Request for Service

What Is VA Form 10-10172?

This is a legal form that was released by the U.S. Department of Veterans Affairs on May 1, 2019 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is VA Form 10-10172?
A: VA Form 10-10172 is a form used to request services from a community care provider.

Q: What is a community care provider?
A: A community care provider is a non-VA health care provider who can provide medical services to eligible VA patients.

Q: Who can use VA Form 10-10172?
A: VA Form 10-10172 can be used by VA patients who need medical services that cannot be provided by the VA.

Q: What information is required on VA Form 10-10172?
A: VA Form 10-10172 requires information such as the patient's name, contact information, medical condition, requested services, and the community care provider's information.

Q: What should I do with the completed VA Form 10-10172?
A: Once you have completed VA Form 10-10172, you should submit it to your local VA health care facility for processing.

Q: How long does it take to process VA Form 10-10172?
A: The processing time for VA Form 10-10172 may vary, but the VA aims to process requests for community care services in a timely manner.

Q: Can I appeal if my request for community care services is denied?
A: Yes, if your request for community care services is denied, you have the right to appeal the decision.