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JAN 2011. 21-0960M-12. SECTION III INITIAL RANGE OF MOTION (ROM) MEASUREMENTS. 3. MEASURE ROM WITH A GONIOMETER, ROUNDING EACH ...
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How to fill out va form 21-0960m-12
How to fill out VA Form 21-0960M-12:
01
Start by downloading VA Form 21-0960M-12 from the official Department of Veterans Affairs (VA) website.
02
Begin with the "Veteran's Identification Information" section. Fill in your full name, social security number, date of birth, and contact information.
03
In the "Claims Information" section, indicate the specific veteran benefit you are seeking by checking the appropriate box. Provide any related service or claim numbers if applicable.
04
Proceed to the "Medical Provider Information" section. Fill in the name, address, and contact information of the healthcare provider who will be providing the medical opinion or evaluation.
05
Complete the "Appointment Request" section by specifying your preferred appointment date and time, as well as any special accommodations you may require.
06
In the "Veteran's Signature and Date" section, sign and date the form to certify your agreement and understanding of the provided information.
07
Next, the "Medical Provider's Signature and Date" section should be left blank. This section will be completed and signed by the medical provider once they have performed the necessary evaluation or examination.
08
Finally, review the completed form for accuracy and ensure that all required fields are filled. Make copies for your records before submitting the original form to the appropriate VA office as instructed on the form.
Who needs VA Form 21-0960M-12:
01
Veterans who are seeking medical evaluation or opinions related to their disability claims.
02
Specifically, this form is used for musculoskeletal or joint-related conditions, such as those related to the spine, upper extremities, or lower extremities.
03
It is required for veterans who are applying for disability benefits related to these specific conditions or requesting a re-evaluation of an existing disability claim.
Note: It is always recommended to consult with a VA representative or a healthcare provider if you have any specific questions or need assistance in completing VA Form 21-0960M-12 accurately.
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What is va form 21-0960m-12?
The VA form 21-0960m-12 is a form used by the Department of Veterans Affairs to evaluate a veteran's mental health condition and determine eligibility for benefits.
Who is required to file VA form 21-0960m-12?
Veterans who are seeking mental health benefits from the Department of Veterans Affairs are required to file VA form 21-0960m-12.
How to fill out VA form 21-0960m-12?
VA form 21-0960m-12 must be completed by the veteran or their representative and submitted to the Department of Veterans Affairs along with supporting documentation.
What is the purpose of VA form 21-0960m-12?
The purpose of VA form 21-0960m-12 is to assess a veteran's mental health condition and determine eligibility for mental health benefits.
What information must be reported on VA form 21-0960m-12?
VA form 21-0960m-12 requires information about the veteran's mental health history, treatment, symptoms, and impact on daily life.
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