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ATTACHMENT 12 Quality Assurance Surveillance Plan (QASP)For: Cookeville, TN CBOCContract Number: VA24914D___Contract Description: To improve access to primary care and mental health/telemental health
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How to fill out a va home-based telemental

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How to fill out a va home-based telemental

01
Obtain the necessary VA forms for home-based telemental health services.
02
Fill out the personal information section, including your contact details and military history.
03
Specify the nature of your mental health needs and any prior diagnoses.
04
Provide information about your current treatment plan or past therapies you've undergone.
05
Indicate your preferred method of communication for telemental health sessions (video, phone, etc.).
06
Sign and date the form, verifying the information is accurate to the best of your knowledge.
07
Submit the completed form to your designated VA healthcare provider for review.

Who needs a va home-based telemental?

01
Veterans experiencing mental health challenges who prefer or require remote access to care.
02
Individuals who may have mobility issues or live in rural areas with limited access to mental health facilities.
03
Veterans seeking ongoing mental health support while managing other commitments or responsibilities.
04
Those who have previously utilized VA mental health services and wish to continue receiving care in a more flexible format.

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A VA home-based telemental is a mental health service provided by the Department of Veterans Affairs that allows veterans to receive mental health support and therapy remotely from their homes through telecommunication technologies.
Veterans who wish to access mental health services via telehealth and who are enrolled in the VA healthcare system are required to initiate the process for a VA home-based telemental.
To fill out a VA home-based telemental, veterans must complete the necessary VA forms, which may include providing personal information, consent for telehealth services, and any relevant medical history. This can often be done online or through a healthcare provider.
The purpose of a VA home-based telemental is to increase access to mental health care for veterans, allowing them to receive necessary therapy and support from the comfort of their homes, thus overcoming barriers such as distance and mobility issues.
Information that must be reported includes personal identification details, health insurance information, consent for telehealth, medical and mental health history, and specifics regarding the services required.
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