Va Form 28 8861 PDF Details

Accessing medical services is a critical component of support for veterans navigating their journey towards rehabilitation and employment. The VA Form 28-8861, titled Request for Medical Services under Chapter 31, plays a pivotal role in this process. Crafted by the Department of Veterans Affairs, this form serves as a communication tool between Vocational Rehabilitation Specialists or Counseling Psychologists and medical professionals. Its primary aim is to ensure veterans participating in Chapter 31, Title 38, U.S.C., receive the necessary medical or dental treatments conducive to their rehabilitation goals. This form is meticulously designed to capture comprehensive information about the veteran, including personal details, service history, and rehabilitation objectives. It further allows the referring professional to articulate the reasons for the medical referral and suggest preferred days and times for appointments, making the process as streamlined as possible for the veteran. On the flip side, medical personnel are provided a section to detail the services rendered and the outcome of the case, ensuring a holistic approach to the veteran's care. The collaboration facilitated by the VA Form 28-8861 underscores a commitment to the health and well-being of veterans, aiding their transition into meaningful employment or training endeavors by addressing their medical and dental needs.

QuestionAnswer
Form NameVa Form 28 8861
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names28 8861, form 28 8861, 28 8861 pdf, 28 8861 form

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Department of Veterans

REQUEST FOR MEDICAL SERVICES - CHAPTER 31

 

Affairs

PART I - (To be completed by Vocational Rehabilitation Specialist or Counseling Psychologist

TO

Director (136)

RETURN

TO

Vocational Rehabilitation and Counseling Division

INSTRUCTIONS: The veteran named below is a participant under Chapter 31, Title 38, U.S.C. Determine whether he or she needs medical or dental treatment and, if needed, provide under appropriate VA Regulations. If the veteran’s medical condition either requires a leave of absence or makes training or employment questionable,

include this information in item 16.

1. FIRST - MIDDLE - LAST NAME OF VETERAN

 

2. TELEPHONE NUMBER (Include Area Code)

3. SOCIAL SECURITY

 

 

 

 

NUMBER

 

 

 

 

 

2. ADDRESS OF VETERAN

 

5. SERVICE DATES (Mo., day, yr.)

6. VA FILE NUMBER

 

 

FROM

TO

 

 

 

 

 

7. DOB (Mo., day, yr.)

 

 

 

 

 

8. REHABILITATION OBJECTIVE OF VETERAN

 

 

9. ANTICIPATED DATE OF REHABILITATION

 

 

 

10A. SERVICE-CONNECTED DISABILITIES

10B. COMBINED SERVICE-CONNECTED DISABILITY

10C. NONSERVICE-CONNECTED DISABILITIES

 

RATING

 

 

 

 

 

 

 

11. DESCRIBE REASONS FOR REFERRAL

12.PREFERRED DAY AND TIME FOR APPOINTMENT

13.SIGNATURE OF VOCATIONAL REHABILITATION SPECIALIST OR COUNSELING PSYCHOLOGIST

14. TELEPHONE

15. DATE

PART II - (To be completed by medical personnel)

16A. REPORT OF SERVICES PROVIDED AND DISPOSITION OF CASE

16B. CHECK BOX IF APPLICABLE

SEPARATE MEDICAL REPORT WILL FOLLOW

17. SIGNATURE OF EXAMINING PHYSICIAN

18. DATE

VA FORM AUG 1990 28-8861

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Filling out this document will require attentiveness. Make sure all required areas are filled out correctly.

1. The form 28 8861 involves particular details to be typed in. Make sure the following blank fields are filled out:

va 28 8861 completion process explained (stage 1)

2. After filling out the last step, go to the next stage and fill in all required particulars in all these fields - ADDRESS OF VETERAN, TELEPHONE, DATE, PART II To be completed by, and A REPORT OF SERVICES PROVIDED AND.

Completing part 2 of va 28 8861

3. This next segment will be about A REPORT OF SERVICES PROVIDED AND, VA FORM AUG, SEPARATE MEDICAL REPORT WILL FOLLOW, and DATE - fill out all of these empty form fields.

Tips to fill out va 28 8861 part 3

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