VA Form 10-10143c Screenshot

VA Form 10-10143c (Statement Question # 1d on Credentialing).jpg

Expanded Acess to Non-VA Care Through the Veterans Choice Program

VA Form 10-10143c Screenshot

OMB: 2900-0823

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 2900-0823 can be found here:

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