VA Form 10-0454. Military Treatment Facility Referral to VA Liaison

VA Form 10-0454 is a referral form used by military treatment facilities to refer active-duty service members, retirees, and their beneficiaries to the VA for medical care. The main purpose of this form is to facilitate the transfer of medical care from military treatment facilities to the VA. 

The form consists of two pages and includes important fields such as patient information, medical history, and reason for referral. The parties involved in this form are the military treatment facility and the VA. 

When compiling the form, the military treatment facility will be required to provide patient information such as name, contact information, and social security number. Additionally, the facility will need to provide information about the patient's medical history and the reason for referral to the VA. 

The military treatment facility must attach supporting documentation such as copies of the patient's medical records and test results. 

An example of using this form would be a military treatment facility referring an active-duty service member who is retiring to the VA for ongoing medical care. 

The benefits of using this form include the opportunity for the patient to receive ongoing medical care from the VA. However, the challenge and risk associated with this form is ensuring that all necessary medical information is provided to the VA for continuity of care. 

Related forms include the VA Form 10-10EZ Application for Health Benefits and the VA Form 10-10CG Application for Comprehensive Assistance for Family Caregivers Program. An alternative form is the VA Form 10-0485 Request for and Authorization to Release Medical Records or Health Information, which is used to request medical records from the VA. 

The completion and submission of this form can significantly impact the future of the participants by ensuring continuity of medical care and access to VA medical benefits. The form can be submitted electronically or by mail to the appropriate VA facility. The VA will store the completed form and medical records in the patient's electronic health record.