A State Veterans Home must send this certification, with the Veteran's 10-10EZ or 10-10EZR, to the VA medical center of jurisdiction for each resident before VA pays per diem. The home's physician, APRN or PA records the history and physical, diagnoses, service connection, admission orders and the recommended level of care: skilled nursing home, domiciliary or adult day health care.
State Veterans Home staff complete Part I, and the SVH physician, APRN or PA completes and signs Part II. A registered nurse or the clinician signs the Part III evaluation, a therapist or clinician the physical therapy block, a social worker or clinician Part IV, and VA staff Part V.
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State Home Program Application for Veteran Care Medical Certification
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The State Veterans Home physician, APRN or PA signs Part II after entering the referring physician, diagnoses, service connection, recommended care and admission orders. Parts III and IV are signed by a registered nurse, therapist or social worker, or by the clinician, and VA reviewers sign Part V.
Item 41 offers skilled nursing home care, domiciliary care and adult day health care. VA's clinical reviewer then approves or declines the level of care in Part V, using the history, physical, functional evaluation and social work assessment the State Home provided.
Yes. The instructions say the State Home must submit a 10-10EZ (Application for Health Benefits) or 10-10EZR (Health Benefits Update) with the 10-10SH, on paper or electronically. Item 10 notes N/A applies to nursing home and adult day health care admissions for the financial disclosure question.