Common use of MTF Requests for DVA Facility Treatment Clause in Contracts

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.‌

MTF Requests for DVA Facility Treatment. MTF requests for DVA facility treatment under the MOA shall include the following information.‌ 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;‌ treatment; • Responsible MTF, MTF physician, and DoD case manager;‌ manager; • Relevant clinical documentation which shall include history and physical, narrative summary, diagnostic test results, laboratory findings, hospital course, progress notes, etc., as applicable.‌ applicable. Upon acceptance, the DVA facility accepting the Service member for treatment will provide accepting physician, POC information for authorization purposes.‌purposes.