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NHPCO WHV Military History Checklist 2012-2026 free printable template

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MILITARY HISTORY CHECKLIST PATIENT DATA Completed By Patient s Name Date Address Hospice Medical Record Last 4 SSN VETERAN STATUS INFORMATION 1. Did you or your spouse or family member serve in the military 1a* Patient Yes No Did you serve on active duty Yes No Did your service include combat dangerous or traumatic assignments Yes No Do you have a copy of your DD214 discharge papers 1b. Did your spouse serve on active duty Comments 1c* Do you have any immediate family members that served or...
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How to fill out NHPCO WHV Military History Checklist

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How to fill out NHPCO WHV Military History Checklist

01
Obtain the NHPCO WHV Military History Checklist form from the NHPCO website or authorized provider.
02
Start by filling out the personal information section including your name, contact information, and service details.
03
Provide information about your military service, including branch, rank, and dates of service.
04
Include details regarding deployments, combat experience, and any awards or honors received.
05
Complete the section on family military history, noting any relatives who served in the military.
06
Review the checklist for completeness and accuracy.
07
Sign and date the form at the designated area.
08
Submit the completed checklist to the appropriate organization or individual as instructed.

Who needs NHPCO WHV Military History Checklist?

01
The NHPCO WHV Military History Checklist is needed by veterans, service members, and their families who are accessing hospice and palliative care services.
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The NHPCO WHV Military History Checklist is a tool developed by the National Hospice and Palliative Care Organization to help identify and record the military history of patients in hospice care.
The NHPCO WHV Military History Checklist is typically required to be filed by healthcare providers and hospice organizations that are caring for veterans or patients with military history.
To fill out the NHPCO WHV Military History Checklist, caregivers should gather necessary details about the patient's military service, including branch of service, periods of service, and any honors or awards received, then enter this information into the appropriate sections of the checklist.
The purpose of the NHPCO WHV Military History Checklist is to ensure that veterans receive appropriate recognition and care based on their military service background, facilitating access to specific benefits and support services.
The NHPCO WHV Military History Checklist must report information such as the veteran's branch of service, dates of service, rank, specific conflicts served in, and any military honors or awards received.
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