Instructions for Request for Services (RFS) – VA Community Care Network (CCN) Providers


Are you a VA CCN (Community Care Network) provider currently working with veterans?

If yes, this article is for you!


The VA has released a new version of the Request for Services (RFS) Form – VA Form 10-10172.

This 1-page form is now required to request additional services or continuation of care for a VA client.
We recommend submitting the RFS 3–4 weeks prior to the current authorization’s expiration to allow sufficient time for VA review, as processing currently takes approximately 3–4 weeks.

Note: The VA has recently been accepting RFS packets even after the expiration date of the existing authorization—unlike in previous years. So, feel free to submit them if services are still needed.
Just keep in mind: they will not expedite late submissions, as these requests are not considered urgent by the VA.

How to Submit a Complete RFS Packet

Your RFS packet must include:

  1.  VA Form 10-10172 (Page 1 only)

  2.  Typed medical documentation, including a clinical summary and treatment plan

  3. ️ The last two progress notes

All documentation must:

  • Contain two patient identifiers on every page (e.g., name + DOB or last four of SSN)

  • Indicate the total number of sessions completed to date

  • Provide objective evidence of treatment progress (e.g., PHQ-9 or PCL-5 scores over time)

  • Include a brief narrative summarizing clinical progress

  • Offer a clinical justification for continuing care

  • Outline a plan for continued treatment and termination

  • Be signed and dated by the provider

We recommend using the Situation, Action, Result format for the summary:

  • Situation – Describe the veteran’s current symptoms and clinical need

  • Action – Outline the treatment you are proposing (e.g., therapy continuation, medication management)

  • Result – Identify what outcomes you expect from continued care

Tip: The space on the RFS form is limited. Be sure to attach a second page with your full clinical documentation.

 Need Help?

If you need assistance with submitting or faxing the RFS, please email your complete RFS packet to:

referrals@helptherapy.com


We’ll ensure it’s submitted to the appropriate VA facility.




Please NOTE: filling out and sending in this form does not guarantee that you will be granted additional sessions with your clients.  You should wait to continue services with your clients until you are approved for a new authorization or risk not getting paid for your services.