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VA RFS (Request For Service) Form 2026 – In the world of Veterans Affairs (VA) healthcare, accessing community care services efficiently is crucial for veterans’ well-being. VA Form 10-10172, also known as the Community Care Provider – Request for Service (RFS) form, plays a pivotal role in this process. Whether you’re a community healthcare provider, a veteran, or a caregiver navigating VA benefits, understanding this form can streamline requests for medical services, durable medical equipment (DME), or prosthetics. This SEO-optimized guide covers everything you need to know about VA Form 10-10172 in 2026, including its purpose, how to complete it, and submission tips, based on the latest official VA resources.
What is VA Form 10-10172?
VA Form 10-10172 is the official document used by community care providers to request authorization from the Department of Veterans Affairs for clinical services on behalf of veterans. It’s designed for situations where services are not covered under an existing VA authorization, such as continuing care, new specialty referrals, or procedures outside the original Standardized Episode of Care (SEOC). This form ensures that veterans receive necessary care through the VA’s Community Care Network (CCN) or Veterans Care Agreements.
The form serves a dual purpose: one section for medical service requests and another for DME or prosthetics. A separate form is required for each service to avoid delays. As of 2026, the current version of the form was revised in March 2025, reflecting streamlined processes from the Office of Integrated Veteran Care (IVC). It’s essential for providers to use this updated version to comply with VA guidelines.
Key uses include:
- Requesting continuation of care when an authorization is expiring.
- Referring to new specialties.
- Ordering DME like home oxygen or therapeutic footwear.
This form helps bridge VA facilities and community providers, ensuring veterans get timely, coordinated care without interruptions.
Who Needs to Use VA Form 10-10172?
Primarily, community care providers—such as doctors, clinics, or specialists outside VA facilities—use this form to request services for veterans. Veterans themselves don’t typically fill it out, but they benefit from it when receiving care through programs like the VA Community Care program.
Providers in the Indian Health Services (IHS) or Tribal Health Programs (THP) may also use it, with a specific field to indicate this affiliation. If you’re a provider handling VA-authorized referrals, this form is mandatory for precertification-required services to avoid claim denials.
For veterans or caregivers: If your provider mentions an RFS, it’s likely they’re submitting this form on your behalf to extend or add services.
How to Fill Out VA Form 10-10172?
Completing VA Form 10-10172 accurately is key to quick approvals. The form is divided into sections, with mandatory fields for veteran and provider info, plus specific details based on the request type. Always attach supporting medical records, care plans, and documentation to justify medical necessity.
Section I: Veteran & Ordering Provider Information
This section is common to both medical and DME requests:
- Veteran’s full legal name, date of birth.
- VA facility and address.
- VA authorization number.
- Ordering provider’s office name, address, phone, fax, and secure email.
- Indicate if the provider is IHS/THP-affiliated.
Section II: Type of Care Requested (For Medical Services)
- Specify if care is needed within 48 hours (urgent cases require direct VA contact).
- Note if it’s a continuation of care or a new specialty referral.
- Provide ICD-10 diagnosis codes and descriptions.
- List requested CPT/HCPCS codes and descriptions.
- For geriatric/extended care, select options like hospice or skilled home health.
- Include a detailed reason for the request, backed by clinical history, labs, and radiology results.
Section II/III/IV: DME & Prosthetics Requests
- For home oxygen: Include PaO2, O2 saturation, flow rate, and equipment type.
- For general DME: List HCPCS codes, brand/model, measurements, quantity, and ICD-10 codes.
- Indicate if education, training, or fitting has been completed.
- Specify delivery preferences (e.g., to veteran’s home).
- For therapeutic footwear: Assess diabetic/amputation risk scores and describe deformities.
Attestation and Signature
Both parts end with an attestation confirming accuracy and acknowledging VA’s discretion. The ordering provider must print their name, provide their NPI number, sign, and date the form—electronic signatures are accepted in many cases.
Tips for completion:
- Use only one form per service.
- For DME rentals beyond 30 days, submit in advance to prevent disruptions.
- Reference VA’s Clinical Determinations and Indications for criteria on medical necessity.
Submission Process for VA Form 10-10172
Once completed, submit the form via:
- HealthShare Referral Manager (HSRM) portal (preferred for efficiency).
- Fax or secure email to the local VA facility’s community care office.
- Avoid U.S. mail for faster processing.
The VA reviews and notifies the provider of approval or denial via their preferred method. For urgent requests, contact the VA directly first. Previous versions of the form or HSRM online questionnaires are still accepted, but using the latest (March 2025) ensures compliance.
Find your local VA facility contacts at va.gov/find-locations/.
Updates to VA Form 10-10172 in 2026
As of February 2026, the form’s latest revision is from March 2025, with no major changes announced yet. The IVC continues to emphasize streamlined submissions to reduce delays. Providers should check va.gov for any 2026 updates, especially regarding digital submission enhancements or expanded community care options.
Frequently Asked Questions About VA RFS Form 10-10172
What if my request is denied?
VA decisions are based on clinical necessity and availability. You can resubmit with additional documentation or appeal through the provider portal.
Can veterans submit this form themselves?
No, it’s for providers only. Veterans should coordinate with their VA primary care team for referrals.
Is there a deadline for submissions?
Submit as soon as needs are identified, especially for continuations, to avoid care gaps.
Where can I download VA Form 10-10172?
Access the fillable PDF at va.gov/find-forms/about-form-10-10172/.
Conclusion
VA Form 10-10172 is an indispensable tool for ensuring veterans receive seamless community care in 2026. By following this guide, providers can submit effective RFS requests, minimizing delays and maximizing benefits. For the most current details, always refer to official VA sources. If you’re a veteran, reach out to your local VA facility for personalized assistance—your health is their priority.