Fillable Form VA 10-2410

VA 10-2410 is an agreement form that allows individuals to take in a veteran to care for from a hospital in their home for a certain monthly rate. They will have the responsibility of caring for the patient, and can bring the patient back to the hospital anytime if they become too unruly or unreasonable.

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What is Form VA 10-2410?

Form VA 10-2410, Agreement to Provide Home Care for Patient, is a Department of Veterans Affairs agreement form that allows individuals to take in their home a veteran from a hospital to take care for a certain monthly rate. They will have the responsibility of caring for the patient and should bring the patient back to the hospital anytime if they become too unruly or unreasonable.

VA Form 10-2410 is a legal form that was released by the U.S. Department of Veterans Affairs on July 1, 1997, and is now used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form VA 10 2410 will require you to complete the following information:

Name of the Veteran Affairs (VA) station

Address of the VA station

Contact number of the VA station

Name of the patient

Social Security Number (SSN) of the patient

Patient’s claim number issued by the hospital

Name of the patient’s physician

Name of the social worker from the hospital

Agreed monthly rate

Commence date for the agreement

By filling out the VA Form 10 2410, you agree to provide the following home care services such as, but are not limited to:

Assistance with self-care, such as grooming, bathing, dressing, and using the toilet.

Enabling safety at home by assisting with ambulation, transfer (for example, from bed to wheelchair and wheelchair to toilet), and fall prevention.

Assistance with meal planning and preparation, light housekeeping, laundry, errands, medication reminders, and escorting to appointments.

Companionship and engaging in hobbies and activities.

Supervision for someone with dementia or Alzheimer’s disease.

Home care is care that allows a person with special needs to stay in your home. It might be for people who are getting older (aging in place). In the case of the VA 10 2410 Form, it could be for people who are chronically ill, recovering from surgery, or have a disability.

Here’s how you can help patients by offering them home care.

You can give them a greater sense of independence. One of the primary benefits of home care is that it allows patients to continue performing daily duties such as walking, bathing, dressing, and meal preparation. This way, they can live independently at home with your care for as long as possible.

You can provide them with safety, comfort, and convenience. Studies show that patients recover faster and with fewer complications at home than they would in a hospital. With home care, patients can get help managing their medications. This prevents harmful drug interactions, which you can help them avoid if they’re in your home instead of the hospital. By offering patients home care, you can help them stick to their routines in familiar surroundings and maintain a sense of normalcy in their lives.

You can prevent back and forth trips to the hospital. By assisting patients in managing their health conditions at home, they may be able to prevent unnecessary hospital visits. Home care helps by providing regular monitoring and education. As such, patients can have 24/7 access to someone they can call if they’re having troublesome symptoms and aren’t sure what to do.

You can help them save money. Avoiding unnecessary trips to the hospital saves money. Home care can also help the patients save money by delaying or preventing the need for nursing home care or other types of more intensive care.

You can provide them with personalized care. Patients can receive one-on-one attention from you and a care plan that is tailored to their specific needs.

You can provide them with companionship. Friends and family will find it easier to visit the patient at your home rather than in a hospital or facility. As such, patients receive more social connection when there are no time constraints or specified visiting hours. This way you can help the patient alleviate loneliness and bring them closer to their families and friends.

How to fill out Form VA 10-2410?

Using PDFQuick, you can electronically fill out and download a PDF copy of the VA 10-2410 Form in minutes. Fill it out by following the instructions below.

Item 1

Enter the name of the Veteran Affairs (VA) station.

Item 2

Enter the address where the VA is stationed.

Item 3

Enter the telephone number of the VA station.

Item 4

Enter the name of the patient.

Item 5

Enter the patient’s social security number (SSN).

Item 6

Enter the patient’s claim number.

Item 7

Enter the name of the patient’s physician.

Item 8

Enter the name of the social worker in charge of the patient.

Item 9

Enter the amount of your agreed monthly rate.

Item 10

Enter the date you will accept the patient in your home, following the format: Month, Day, Year.

Item 11

Affix your signature.

By signing, you agree to accept the above-named patient into your home on the date indicated on Item 10 at the monthly rate shown on Item 9. You agree to provide the patient with room, board, laundry service, and look after his or her personal welfare. You understand that the patient will be on trial visit status during his or her stay in your home and will be visited at regular intervals by a member of the Social Service Staff from the hospital.

You also agree to notify the patient’s physician or the social worker at the hospital if there are any bad changes in the patient’s condition, either physical or mental, or if the patient has left your home for any period of time without your knowledge or consent. You further agree that it is within your responsibility to notify the social worker or the patient’s physician if your address has been changed or if any other person becomes a member of your household. You have been informed of your right to request the patient’s return to the hospital at any time, if the patient is not able to make a reasonable adjustment.

Item 12

Enter your complete address, including your street address, apartment number, city, state, and ZIP code.

Item 13

Enter the date you signed the form.

Table of Contents

Fillable Form VA 10-2410