VA Form 10-10172 – Printable, Fillable in PDF

ORIGINFORMSTUDIO.COMVA Form 10-10172 – Printable, Fillable in PDF – VA Form 10-10172, also known as the Veteran/Beneficiary Claim for Reimbursement of Travel Expenses, is an essential document that enables veterans and their beneficiaries to receive reimbursement for travel expenses related to medical treatment. This form is provided by the Department of Veterans Affairs (VA) and is used by eligible individuals who have received treatment at VA medical facilities or authorized non-VA medical facilities.

Download VA Form 10-10172 – Printable, Fillable in PDF

Form Number VA Form 10-10172
Form Title Printable, Fillable in PDF
File Size 869 KB
Date 04/2022

What is a VA Form 10-10172?

VA Form 10-10172, also known as the Request for and Consent to Release of Information from Individual Records, is used by veterans or their authorized representative to request information from their VA records. The form authorizes the release of information that is pertinent and necessary for a particular purpose or to a specific entity.

The VA Form 10-10172 contains sections where the veteran or their representative can specify the type of information they need and where it should be sent. It also includes an option for the veteran to limit what information is released and to whom it is released. This ensures that sensitive medical, financial, or personal information remains confidential.

It’s important for veterans or their representatives to fill out this form accurately and completely because incomplete forms may delay the release of requested information. Additionally, providing too much unnecessary information on this form could potentially lead to unintended disclosure. Therefore, it’s critical that those requesting access to VA records read all instructions carefully before filling out this form.

What is the Purpose of VA Form 10-10172?

VA Form 10-10172 is a document that serves as an official request for veterans to receive medical care from the Department of Veterans Affairs (VA). The form includes essential information about the veteran’s medical history, treatment needs, and eligibility for VA healthcare benefits. Veterans must submit this form to initiate the process of receiving medical care through the VA.

The purpose of this form is to ensure that veterans receive the necessary and appropriate medical care they require based on their specific health conditions. It also helps streamline the process of accessing VA healthcare services by providing clinicians with relevant information about each patient’s medical history. Additionally, submitting this form allows veterans to establish a relationship with a primary care provider within the VA system who can help coordinate their ongoing healthcare needs. In summary, completing and submitting VA Form 10-10172 is crucial for veterans seeking quality and consistent access to medical care through the Department of Veterans Affairs.

Where Can I Find a VA Form 10-10172?

VA Form 10-10172, also known as the Request for and Authorization to Release Health Information, is an essential document for veterans seeking medical treatment. It allows healthcare providers to access a veteran’s medical records from previous treatments and helps streamline the process of obtaining necessary information for current care.

To obtain this form, veterans can visit their local VA medical center or download it online. The form is readily available on the VA website in a printable format that can be filled out electronically or by hand. Veterans should ensure that they fill out all sections accurately and completely before submitting it to their healthcare provider.

Moreover, if a veteran needs assistance with filling out the form or has questions about the release of health information, they can reach out to their local VA facility’s patient advocate office for guidance. Overall, obtaining and completing VA Form 10-10172 is an important step towards ensuring quality healthcare services for veterans.

VA Form 10-10172 – Printable, Fillable in PDF

VA Form 10-10172 is a form used by veterans to apply for the Veteran Readiness and Employment (VR&E) program. This program provides assistance to service-disabled veterans in finding and maintaining suitable employment, as well as helping them achieve their educational goals. The form is available in both printable and fillable PDF formats, making it easy for veterans to complete and submit online or via mail.

The VA Form 10-10172 includes important personal information such as name, address, social security number, and military service history. It also requires detailed information about the veteran’s disability status, employment history, education level, and vocational goals. Additionally, the form requires signatures from both the veteran and a representative of the Department of Veterans Affairs (VA), acknowledging receipt of the application.

Overall, VA Form 10-10172 is an essential tool that enables eligible veterans to access vital resources through VR&E. By completing this form accurately and thoroughly, veterans can receive support in pursuing meaningful careers after serving our country with honor and distinction.

VA Form 10-10172 Example

VA Form 10-10172 - Printable, Fillable in PDF Part 1
VA Form 10-10172 – Printable, Fillable in PDF Part 1
VA Form 10-10172 - Printable, Fillable in PDF part 2
VA Form 10-10172 – Printable, Fillable in PDF part 2