MTF Requests for DVA Facility Treatment Sample Clauses

MTF Requests for DVA Facility Treatment. MTF requests for DVA facility treatment under the MOA shall include the following information.‌ • Reason for referral, list of all current diagnoses including International Classification of Diseases, Clinical Modification 9 (ICD-9-CM), and any expectations for treatment;‌ • Responsible MTF, MTF physician, and DoD case manager;‌ • Relevant clinical documentation which shall include history and physical, narrative summary, diagnostic test results, laboratory findings, hospital course, progress notes, etc., as applicable.‌ Upon acceptance, the DVA facility accepting the Service member for treatment will provide accepting physician, POC information for authorization purposes.‌
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MTF Requests for DVA Facility Treatment. MTF requests for DVA facility treatment under the MOA shall include the following information. • Reason for referral, list of all current diagnoses including International Classification of Diseases, Clinical Modification 9 (ICD-9-CM), and any expectations for treatment; • Responsible MTF, MTF physician, and DoD case manager; • Relevant clinical documentation which shall include history and physical, narrative summary, diagnostic test results, laboratory findings, hospital course, progress notes, etc., as applicable. DoD/DVA MOU Appendix APolytrauma, SCI, TBI, and Blindness 6 Upon acceptance, the DVA facility accepting the ADSM for treatment will provide accepting physician, POC information for authorization purposes.
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MTF Requests for DVA Facility Treatment. MTF requests for DVA facility treatment under the MOA shall include the following information. • Reason for referral, list of all current diagnoses including International Classification of Diseases, Clinical Modification 9 (ICD-9-CM), and any expectations for treatment; • Responsible MTF, MTF physician, and DoD case manager; • Relevant clinical documentation which shall include history and physical, narrative summary, diagnostic test results, laboratory findings, hospital course, progress notes, etc., as applicable. MEMORANDUM OF AGREEMENT (MOA) BETWEEN DEPARTMENT OF VETERANS AFFAIRS (DVA) AND DEPARTMENT OF DEFENSE (DOD) FOR MEDICAL TREATMENT PROVIDED TO ACTIVE DUTY SERVICE MEMBERS (ADSMS) WITH SPINAL CORD INJURY (SCI), TRAUMATIC BRAIN INJURY (TBI), BLINDNESS, OR POLYTRAUMATIC INJURIES DoD/DVA MOU Appendix A Polytrauma, SCI, TBI, and Blindness 6 Upon acceptance, the DVA facility accepting the ADSM for treatment will provide accepting physician, POC information for authorization purposes.
Sample 1
MTF Requests for DVA Facility Treatment. MTF requests for DVA facility treatment under the MOA shall include the following information. • Reason for referral, list of all current diagnoses including International Classification of Diseases, Clinical Modification 9 (ICD-9-CM), and any expectations for treatment; • Responsible MTF, MTF physician, and DoD case manager; • Relevant clinical documentation which shall include history and physical, narrative summary, diagnostic test results, laboratory findings, hospital course, progress notes, etc., as applicable. Memorandum Of Agreement (MOA) Between Department Of Veterans Affairs (DVA) And Department Of Defense (DoD) For Medical Treatment Provided To Active Duty Service Members (ADSMs) With Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI), Blindness, Or Polytraumatic Injuries DoD/DVA MOU Appendix A Polytrauma, SCI, TBI, and Blindness 6 Upon acceptance, the DVA facility accepting the ADSM for treatment will provide accepting physician, POC information for authorization purposes.
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Related to MTF Requests for DVA Facility Treatment

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