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The Request for Service (RFS), VA Form 10-10172, is the standard VHA document used by community providers to request authorization from the VA for clinical care on behalf of Veterans. Community Providers are required to submit an RFS request to the local VA when a clinical evaluation has determined the need for 1) continuation of care (current authorization is expiring and/or the maximum number of visits authorized has been reached); 2) a new specialty service referral; and/or 3) when a procedure or service, not included in the original Standardized Episode of Care (SEOC), is needed.

• Online Request for Services (RFS) Form
• Community providers are now able to submit online RFS Form through HSRM. This form will allow electronic signature of the RFS and can be access from 2 security groups:
• Community Staff – will allow provider staff to access and create RFS.
• Community Care Provider – will allow credentialed providers to access, create, and sign RFS.
• To submit the online RFS, the provider facility must have at least 1 user with the ‘Community Care Provider’ security group to electronically sign the RFS form.
• To obtain the Community Care Provider security group, please ask the CCRA HSRM Administrator for your facility to submit an updated End User Tracker (EUT) to HSRMSupport@va.gov.
• To receive this security role, you must be an MD, DO, NP, PA, DPT, DC, Acupuncturist, Massage therapist, or Respiratory Therapist. You must also have an active ID.me account.

For additional information on how to submit an online RFS in HSRM, please review section 4.11 of the HSRM Community Provider User Guide and page 8 of the HSRM Community Provider Quick Reference Guide