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The OMB Control No. for this information collection is 2900-0556. VA FORM JUL 2015 10-0137 Page 1 of 7 PART II DURABLE POWER OF ATTORNEY FOR HEALTH CARE This section of the advance directive form is called a Durable Power of Attorney for Health Care. OMB Approval Number 2900-0556 Estimated Burden Avg 30 minutes Expiration Date 10/31/2017 VA ADVANCE DIRECTIVE DURABLE POWER OF ATTORNEY FOR HEALTH CARE AND LIVING WILL This advance directive form is an official document where you can write down...

How to fill out va form 10 0137

How to fill out VA 10-0137

1. Start by obtaining a copy of VA Form 10-0137 from the official VA website or local VA office.
2. Fill in your personal identification details at the top of the form, including your name, address, and Social Security number.
3. Indicate your service information, including branch of service and dates of service, in the designated section.
4. Provide any relevant contact information, such as phone number or email, for follow-up purposes.
5. Detail the specific medical services requested, ensuring to include any pertinent information regarding your health conditions.
6. Review the completed form carefully for accuracy and completeness.
7. Sign and date the form in the designated area at the bottom.
8. Submit the form either by mailing it to the appropriate VA facility or delivering it in person.

Who needs VA 10-0137?

1. Veterans seeking to obtain health care services through the VA.
2. Individuals who are eligible for VA benefits and require assistance with specific medical needs.
3. Caregivers or family members of veterans who are completing the form on their behalf.

People Also Ask about

Who can witness an advance directive in Virginia?

"Witness" means any person over the age of 18, including a spouse or blood relative of the declarant. Employees of health care facilities and physician's offices, who act in good faith, shall be permitted to serve as witnesses for purposes of this article. 1983, c. 532, § 54-325.8:2; 1984, c.

Does a Virginia power of attorney require witnesses?

You must sign the Power of Attorney, but you do not need witnesses to your signature. You should have your signature notarized. A lawyer should write a Power of Attorney for you because the language must be very specific.

Who can witness a Virginia Advance Directive?

In Virginia, you do not need an attorney—or even a notary—to complete an Advance Directive. Just two witnesses. Your family may witness the document, even if they are listed as decision makers on the directive. Or, our office staff can witness the document for you.

What makes an advance care directive legal?

Formal advance care planning is only legally possible when a person is competent or has decision-making capacity. Without this, they are unable to make informed decisions. An adult is presumed to have decision-making capacity unless there is evidence to the contrary.

Does an advance medical directive need to be notarized in Virginia?

Does an Advance Directive in Virginia need to be notarized? No. An Advance Directive registry for Virginia is being developed, and when it becomes operational, a notary will be required to post an Advance Directive on the registry. Advance Directives without a notary still will be valid for other purposes.

Does a medical power of attorney need to be witnessed in Virginia?

Does a Medical Power of Attorney need to be notarized in Virginia? No, your VA Medical Power of Attorney doesn't need to be notarized, but you must sign the form in the presence of two witnesses to be legally binding.

Does a medical power of attorney need to be notarized in Virginia?

While Virginia does not technically require you to get your POA notarized, notarization is very strongly recommended. Under Virginia law, when you sign your POA in the presence of a notary public, your signature is presumed to be genuine—meaning your POA is more ironclad.

What is Virginia Advance Medical Directive?

All adults in Virginia have a right to prepare a document called an “advance directive” to put their wishes regarding medical care in writing. An advance directive lets other people know the types of medical care you do and do not want in the event you are unable to express your wishes on your own.

What you should know about advance directives VA?

In a VA advance directive, you can say how strictly you want your wishes followed. You can tell your health care agent to do just what your living will says, or you can tell them to make the decision they think is best for you even if it isn't what the living will says.

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What is VA 10-0137?

VA 10-0137 is a form used by veterans to request reimbursement for non-VA emergency treatment.

Who is required to file VA 10-0137?

Veterans who have received non-VA emergency treatment and seek reimbursement from the Department of Veterans Affairs (VA) are required to file VA 10-0137.

How to fill out VA 10-0137?

To fill out VA 10-0137, provide personal information such as your name, service number, and details of the emergency treatment received, including the date of service, facility name, and any related expenses.

What is the purpose of VA 10-0137?

The purpose of VA 10-0137 is to initiate a request for reimbursement for out-of-pocket expenses incurred during non-VA emergency medical care.

What information must be reported on VA 10-0137?

The form requires reporting personal identification information, details of the emergency treatment including location, dates, and costs associated with the treatment, as well as insurance information if applicable.