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  • VA Referral Form

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  • Client Information

  • Client Needs

  • Acknowledgement

  • Thank you for submitting a referral to our agency. The information you have provided will help us begin the initial review of the client’s needs and potential service options.

    By submitting this referral, you acknowledge the following:

    • All information provided is true and accurate to the best of your knowledge.
    • Submission of this referral does not guarantee services.
    • The client’s eligibility for non-medical home care is determined solely by AVCC (American Veterans Care Connection) based on their internal criteria, documentation requirements, and benefit review.
    • Our agency may contact you or the client for additional information if needed to complete the referral process.
    • Services may begin only after AVCC issues approval and funding authorization.

    If you have any questions or need assistance updating referral information, please contact our team.

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