VA Form 10-7959f-2 at a glance
What it is: Foreign Medical Program (FMP) Claim Cover Sheet: to obtain reimbursement for medical services outside the United States.
Who signs: In SECTION III - CLAIMANT CERTIFICATION, sign the VETERAN SIGNATURE (Required) and enter the DATE (Required) (MM/DD/YYYY).
What to bring and attach to VA Form 10-7959f-2
Attach itemized invoices or receipts.
A filled-in VA Form 10-7959f-2 example: a Veteran files a claim for care abroad
How to fill out VA Form 10-7959f-2, box by box
SECTION I - VETERAN INFORMATION
In Section I - Veteran Information (Please Print), enter the Veteran Last Name, Veteran First Name and MI.
Enter the SOCIAL SECURITY NUMBER as 999-99-9999 and the DATE OF BIRTH as MM/DD/YYYY.
Enter the PHYSICAL ADDRESS (Residence) and the MAILING ADDRESS.
Enter the TELEPHONE NUMBER as (999) 999-9999 and the EMAIL ADDRESS.
SECTION III - CLAIMANT CERTIFICATION
In SECTION III - CLAIMANT CERTIFICATION, sign the VETERAN SIGNATURE (Required) and enter the DATE (Required) (MM/DD/YYYY).
By signing you certify that the information and attachments are correct and represent actual services, dates, and fees charged.
Federal law provides criminal penalties, including a fine and/or imprisonment, for any materially false, fictitious, or fraudulent statement or representation (See 18 U.S.C. 287 and 1001).
PAYMENT TO BE SENT TO? (Check one box)
PAYMENT TO BE SENT TO? (Check one box): VETERAN PROVIDER
Attach a receipt of payment for each itemized billing statement(s) to process reimbursement and send payment to the Veteran or Provider.
More rules for VA Form 10-7959f-2
Payment is based on the exchange rate on the date service was rendered.
All claim forms must be accompanied by the provider's itemized billing statement(s) which must include Provider Information: 1.) Full name and medical title 2.) Office address 3.) Office telephone number 4.) Billing address if different from office address Claim Information - Diagnosis treated: 1.) Narrative description of each service and/or drug 2.) Each service's billed change 3.) Date(s) of service
If your situation is different
The claim has other health insurance
If a claim has been submitted to Other Health Insurance (OHI), attach the Explanation of Benefits (EOB) from the other health insurance company and an itemized billing statement. Dates of service and provider charges on the EOB must match billing statements.
Common questions about VA Form 10-7959f-2
Is there a deadline?
Claims must be received no later than two years from the date of service, or in case of inpatient care, within two years from the date of discharge.
Where do I file it?
Foreign Medical Program (FMP): PO Box 200, Spring City, PA 19475.
Sources
[1] VA Form 10-7959f-2 (AUG 2025), Foreign Medical Program (FMP) Claim Cover Sheet, Department of Veterans Affairs (the Official source link on this page).