Community Care

Forms on this site are available in several formats. Fillable Portable Document Formats can be completed online, edited, saved and printed. Other forms are blank, printable forms which need to be completed offline and mailed. Please visit the VA Forms page to search for a specific VA form.

On this page

• General Information
• CHAMPVA
• Camp Lejeune
• Children of Women Vietnam Veterans
• Spina Bifida
• Foreign Medical Program
• Forms for Providers

General Information

• Request For and Authorization To Release Medical Records, VA Form 10-5345 (Fillable PDF)
  NOTE: Only use this form for one time release of information.
• Veteran Reimbursement Claim Form, VA Form 10-320 (Fillable PDF)
• Claim for Miscellaneous Expenses, VA Form 10-7959e (Fillable PDF)
  NOTE: This form is not for provider use.

CHAMPVA

• CHAMPVA Application for Benefits, VA Form 10-10d (Fillable PDF)
• CHAMPVA Claim Form, VA Form 10-7959a (Fillable PDF)
  NOTE: This form is not for provider use.
• CHAMPVA Other Health Insurance (OHI) Certification, VA Form 10-7959c (Fillable PDF)
• CHAMPVA School Enrollment Certification Letter (Fillable PDF)

Camp Lejeune Family Member Program (CLFMP)

• Camp Lejeune Family Member Program Application, VA Form 10-10068 (Fillable PDF)

Children of Women Vietnam Veterans (CWVV)

• Application for Benefits for a Qualifying Veteran's Child Born with Disabilities, VA Form 21-0304 (Fillable PDF)
  for Children of Women Vietnam Veterans Born with Certain Birth Defects–38 U.S.Code 1815

Spina Bifida Health Care Benefits Program (SBHCBP)

• Application for Benefits for a Qualifying Veteran's Child Born with Disabilities, VA Form 21-0304 (Fillable PDF)
  for Spina Bifida Benefits Eligibility

Foreign Medical Program (FMP)

• FMP Claim Cover Sheet, VA Form 10-7959f-2 (Fillable PDF)