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VA Form 10-2850C Printable, Fillable in PDF – When a veteran’s profession is not mentioned on VA Form 10-2850, he or she must complete VA Form 10-2850C, also known as an Application for Associated Health Occupations, which is used by the Department of Veterans Affairs. Respiratory therapy technicians, physical therapists, pharmacists, and physician’s assistants are examples of occupations that are not included in this form. The Department of Veterans Affairs will use this paper to obtain specific personal information about the applicant, which will be handled by them. Additional information will be collected via the VA Form 10-2850C, including clinical privileges, active military service information, professional credentials and references, and any other information that will be useful to the Department in making a final decision. For the Department to make the best-informed judgment possible, this information must be as accurate as possible. This form may be completed in less than 30 minutes if you have all of the necessary papers available.
What is a VA Form 10-2850C?
The Department of Veterans Affairs in the United States uses this form. An applicant for Associated Health Occupations (VA Form 10-2850C) is the official name for this form. A person who is not identified on the other VA Form 10-the 2850s will utilize this form to apply for a VA disability allowance. Respiratory therapy technicians, physical therapists, pharmacists, and physician’s assistants are all examples of professionals that might fall into this category.
This form will ask for extensive information about the candidate, including their medical training and work experience. The Department of Veterans Affairs will verify all of the information you supply. Personal information, educational data, employment experience, and references will all be required on your application. When filling out the application, be as precise as possible, since this will increase your chances of being accepted as a member of the Veterans Health Administration (VHA).
Health care professionals who want to be appointed by the Veterans Health Administration and for whom no other 10-2850 form is applicable often utilize the VA Form 10-2850C, which is available on the VA’s website.
A VA Form 10-2850C Is Composed Of Many Parts
- The following parts are included in VA Form 10-2850C: 1.
- Particulars about the individual
- Military Service in the Active Defense Forces
- The following credentials are required: licensees must be DEA certified, registered, and have clinical privileges
- Qualifications
- Having worked in the Industry
- Informative notes about the subject
- References
- Signature
- Obtaining Permission for the Publication of Information
Form 10 2850c (Veterans Affairs): How To Complete It (Step By Step)
You will need to supply the following information on the VA Form 10-2850C form to finish it.
Particulars about the individual
- Application for certified respiratory therapy technicians, registered respiratory therapists, licensed physical therapists, licensed practical/vocational nurses, licensed pharmacists, physician assistants, expanded-function dental auxiliary, occupational therapists, and other positions is being accepted.
- Name
- Use this form for general practice or a specialization
- Address
- Number of a phone
- Whatever the setting, whether it’s a home or a company
- Identifying information such as birth date
- Geographical origins
- Identification number (SSN)
- Status as a citizen
- Residence and citizenship are determined by the following criteria:
- Whether or not you have ever applied to the appointment with the Veterans Administration.
- Filing address of the office where the documents were received
- The date on which the document was submitted
- Inquire with your current employer about whether or not VA may conduct an inquiry.
- available to start work on a certain day
Military Service in the Active Defense Forces
- At the beginning of the year
- Until what date
- The serial number or service number is a unique identifier.
- The service branch is divided into two categories:
- how the discharge is carried out
The following credentials are required: licensees must be DEA certified, registered, and have clinical privileges
- List of all states and territories in which you are now or have previously had a valid license (if applicable).
- The number of valid licenses.
- regardless of whether or not your registration is up to date
- The date on which something is no longer valid.
- The fact that you have a license regardless of whether or not you have a license in every state is immaterial.
- Whatever your current or previous license status (revoked, suspended, denied, restricted, or limited), whether you have been put on probation, whether you have voluntarily abandoned your license, or if you are considering doing so
- Whether you have ever had a registration to practice medicine that is no longer valid.
- Affiliation with the certifying organization for your health profession
- Recent registration/certification information is provided.
- A numerical identifier for registration or certification
- Any action was taken against your certification or registration, or if any such action has ever been taken against you
- You have clinical privileges at a healthcare institution or agency, whether you presently hold them or have had them in the past.
- Identification of the current or most recent rights possessed, as well as the address of the privilege holder
- Whether any of your staff appointments or clinical privileges have ever been rejected, revoked, suspended, limited, or not renewed, or whether you have willingly abandoned any of your appointments or clinical privileges.
Insurance for Liability
- Professional liability insurance is provided by the current insurance provider.
- Coverage started on the date specified.
- Prior carriers’ names are shown here.
- Coverage periods are as follows:
- Whether or not you have ever had your coverage terminated, rejected, or refused to renew by any provider.
Qualifications
- Education in the Basics of Allied Healthcare
- Identifying information on the establishment
- Address
- Program duration is specified in minutes.
- Completed on the specified day
- Accomplished a diploma or a degree
Furthering one’s knowledge
- Identifying information on the establishment
- Address
- Major
- Completed on the specified day
- Credits
- Degree
Having worked in the Industry
- Employer
- Address
- Position
- The position’s availability regularly
- Weekday hours worked as a part-time employee
- The dates that were used were
Informative notes about the subject
- If you were employed under a name other than the one you provided in your application, please include that name.
- A complete list of all professional publications, scientific articles, honours, awards, research funding, and fellowships is available on request.
- References
- Whether you have received or are considering applying for retirement or retainer pay, a pension, or other forms of compensation.
- You should find out whether any of your family are employed with the Veterans Administration.
- Whatever your current or former involvement (administrative, professional, or judicial procedure) in which malpractice has been asserted during the last five years, you may be eligible for a monetary award.
- No matter if you have been fired from employment within the past five years.
- Whatever your reason for leaving or retiring from a post after being informed that you will be penalized or fired, or after concerns about your competence were raised, we want to hear about it.
- Whether you have ever been convicted of a crime or a guns or explosives infraction against the law, have forfeited collateral, or are now facing prosecution, we can help you.
- For any crime against the law for which you have been convicted, sentenced to prison/probation/parole, or forfeited collateral, or are now facing accusations during the last seven years, you may be eligible for this program.
- Irrespective of whether or not you were convicted by general court-martial while serving in the military
- No matter if you were a physician, dentist, podiatrist, optometrist, or chiropractor while serving in the military, you may be entitled to compensation.
- Whether or whether you owe any federal debt, you should consult with an attorney.
Signature
Obtaining Permission for the Publication of Information
- Indication of whether or not you authorize the VA to investigate by contacting your previous employers, current employers, educational institutions, state licensing boards, professional liability insurance carriers, national practitioner data bank, American Medical Association, Federation of State Medical Boards, other professional organizations, and/or persons, agencies, organizations, or institutions listed by me as references, as well as any other source the VA deems appropriate
- To provide permission for the release of associated papers and information to the Department of Veterans Affairs
- Those who disclose information to the VA in response to such queries in good faith are released from responsibility.
- Authorization allows the Department of Veterans Affairs to share identifiable information to individuals and groups that inquire about the VA.
- Signature
- Date