Va Form 10 2850a Form

Known as an Application for Nurses and Nurse Anesthetists, VA Form 10-2850 is an application that the Department of Veterans Affairs will use to verify the credentials and qualifications of a nurse or nurse anesthetist. This application allows the nurse or nurse anesthetist to be officially recognized by the Department of Veterans Affairs which, in turn, allows them to treat veterans under their VA insurance. VA Form 10-2850 will collect detailed information about the nurse or nurse anesthetist such as their license or certification information, experience, and education. To improve the chances of a nurse or nurse anesthetist to be recognized it is recommended that he or she include any professional references or awards that can support their application in the decision making process.

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What is a VA Form 10 2850a?

A VA Form 10-2850A is known as an Application for Nurses and Nurse Anesthetists. The form is used by the United States Department of Veterans Affairs. This form will allow a nurse or nurse anesthetist to apply for recognition in the Veterans Health Administration. Being recognized by this organization will allow the nurse or nurse anesthetist to treat veterans under their VA health insurance.
This form requires detailed information about the medical professional in order to be approved. This will include information about the applicant’s qualifications, such as license or certification, education, or other experience.  The Department of Veteran Affairs will verify all this information. To improve the chances of being recognized, include professional references and any honors or awards you have received related to your medical profession.

Most Common Uses

This form is commonly used by nurses and nurse anesthetists to become a part of the Veterans Health Administration.

Components of a VA Form 10 2850a

The VA Form 10-2850a contains the following sections:

  • Personal Information
  • Active Military Duty
  • Registration and Clinical Privileges
  • Nurse Anesthetist Certification
  • Certification by Facility Director or Designee
  • Professional Liability Insurance
  • Qualifications
  • Nursing Experience
  • General Information
  • References
  • Signature
  • Authorization for Release of Information

Paperwork Reduction Act and Privacy Act Notice

The U.S. Department of Veterans Affairs is conducting this information collection to determine your qualifications for employment.  It has authority to do so under Title 38, United States Code, Chapters 73 and 74.  OMB Number 2900-0205.
The information provided on the form may be released without your prior consent to another U.S. government, state, or local agency, to the National Practitioner Data Bank which is administered by the Department of Health and Human Services, to State licensing boards, and other appropriate organizations or agencies.
Disclosure of your social security number is necessary to obtain the employment benefits that you are applying for.  The VA is authorized to ask you for your SSN under Executive Order 9397, dated November 22, 1943.

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