The VA has released a new 1-page RFS form, which must be faxed to the veteran's assigned VA along with a treatment plan and the last two progress notes as supporting documentation.
You can access page 1 of the updated RFS form here:
:link: VA Form 10-10172 (Page 1)

The additional signed medical documentation must be typed, though no specific template is required. At a minimum, it must include the following:
  1. Total number of sessions completed to date
  2. Objective evidence of response to treatment (e.g., PHQ-9 or BDI scores over time for depression; PCL-5 scores over time for PTSD)
  3. A brief (3–5 sentence) narrative summarizing the veteran’s progress in treatment
  4. Clinical justification for extending care (e.g., what benefit is expected from additional sessions that has not yet been achieved?)
  5. A plan for continued treatment and termination
  6. Provider’s signature at the end of the medical documentation

Important: Please include two patient identifiers on all pages submitted.
If you need assistance with submitting or faxing the RFS to the VA, please forward your complete RFS packet to: referrals@helptherapy.com