Va 21p-8416 oct Form 2012-2023

Va 21p-8416 oct 2023 Form: What You Should Know

You may need to complete this form for the following categories of expenses: Medical and dental services provided in a nursing facility. Health-related supplies (including eyeglasses, medication, dental appliances, vitamins and other health items and services). Home health services  Dental services provided at a dentist or other medical facility. Medical treatment provided at a home health care facility. Vascular, orthopedic, and therapeutic services for Veterans, such as counseling and physical therapy. Home health care provided in a home that is not licensed or operated by the Veteran's personal representatives. Food costs at a home health care facility, including food consumed by the Veteran. Cost of the following items used in connection with the care of the Veteran, if the item is paid for through the Federal Health Insurance (Part A) Program administered by the Veterans Health Administration or through a Part B State Medicaid program: Surgical and medical procedures performed in a medical clinic. Dental work performed in a dental clinic. Other diagnostic and medical services. Other medical services, including dental work, except for the following: Medical or dental care in an outpatient hospital. Medical and dental care provided in an emergency room in a hospital. If the Veteran receives benefits from the Department of Veterans Affairs, those benefits may be paid from any source, including a VA medical or dental expense report, which you may be entitled to file with OMB or other appropriate agency.  If the Veteran does not receive benefits from the Department of Veterans Affairs, the Veteran may report those expenses on page 2 of the Form 21P-8416. If the Veteran is paying for lodging, meals or transportation out of his own pocket, the report should include the amounts for lodging, meals, transportation, and the cost of transportation.  If the expenses are paid or reimbursed by the VA or other source, it may also include such reimbursement amounts.

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