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Page 215 of 235

VA Form 10-376(2023)

CARDIAC PRE-OPERATIVE EVALUATION/RISK STRATIFICATION REQUEST

Official Department of Veterans Affairs 10-376 for CARDIAC PRE-OPERATIVE EVALUATION/RISK STRATIFICATION REQUEST, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-379(2024)

Consent and Authorization for Autopsy

Official Department of Veterans Affairs 10-379 for Consent and Authorization for Autopsy, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-380(2025)

VCAP Child Registration Intake Form

Official Department of Veterans Affairs 10-380 for VCAP Child Registration Intake Form, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-381(2025)

VCAP Appointment Certification Form

Official Department of Veterans Affairs 10-381 for VCAP Appointment Certification Form, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-387(2025)

Medical Foster Home Caregiver Application

Official Department of Veterans Affairs 10-387 for Medical Foster Home Caregiver Application, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-3884B(2015)

Automated Exchange of Beneficiary Information and Request for Eligibility Data

Official Department of Veterans Affairs 10-3884B for Automated Exchange of Beneficiary Information and Request for Eligibility Data, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-390(2024)

VHA Fraud, Waste, and Abuse Complaint Form

Use this form to report potential health-care fraud, waste, or abuse in VA programs.

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VA Form 10-394(2025)

Subcutaneous Insulin Infusion (SCII) Pump Patient Log

Official Department of Veterans Affairs 10-394 for Subcutaneous Insulin Infusion (SCII) Pump Patient Log, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-4236A(2018)

Certificate of Reciprocity

Official Department of Veterans Affairs 10-4236A for Certificate of Reciprocity, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-4555B(1998)

Certificate of Medical Feasibility

Official Department of Veterans Affairs 10-4555B for Certificate of Medical Feasibility, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-4790(2009)

Driver Rehabilitation Program Report

Official Department of Veterans Affairs 10-4790 for Driver Rehabilitation Program Report, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-4794(2011)

Audiovisual Data Sheet

Official Department of Veterans Affairs 10-4794 for Audiovisual Data Sheet, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-493(2016)

TRICARE Affirmation

Official Department of Veterans Affairs 10-493 for TRICARE Affirmation, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-493A(2016)

TRICARE for Life Affirmation

Official Department of Veterans Affairs 10-493A for TRICARE for Life Affirmation, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-493B(2016)

CHAMPVA Benefits Election Affirmation

Official Department of Veterans Affairs 10-493B for CHAMPVA Benefits Election Affirmation, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-5018(2015)

Petty Cash Receipt

Official Department of Veterans Affairs 10-5018 for Petty Cash Receipt, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-5023(2007)

Receipt for Miscellaneous Collections

Official Department of Veterans Affairs 10-5023 for Receipt for Miscellaneous Collections, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-5096(2005)

Request For Service or Article (VCS)- Fillable

Official Department of Veterans Affairs 10-5096 for Request For Service or Article (VCS)- Fillable, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-5345(2021)

Request for and Authorization to Release Health Information

Use VA Form 10-5345 to authorize us to share your health information with a non-VA (or third-party) individual or organization.

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VA Form 10-5345A(2021)

Individuals' Request for a Copy of Their Own Health Information

Official Department of Veterans Affairs 10-5345A for Individuals' Request for a Copy of Their Own Health Information, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-5379A(1991)

Special Pay Agreement

Official Department of Veterans Affairs 10-5379A for Special Pay Agreement, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-5379E(2001)

Special Pay Computation - Physicians and Dentists

Official Department of Veterans Affairs 10-5379E for Special Pay Computation - Physicians and Dentists, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-5392(2016)

Occasional Volunteer Time Sheet

Official Department of Veterans Affairs 10-5392 for Occasional Volunteer Time Sheet, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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VA Form 10-5397(2005)

Employee Uniform Allowance Authorization-fill

Official Department of Veterans Affairs 10-5397 for Employee Uniform Allowance Authorization-fill, sourced from the VA public forms catalog for veterans benefits, health care, education, records, and service-related workflows.

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