VA Form 10-5548A Fillable PDF – Pacemaker Surveillance – Veterans with implanted pacemakers can use the official fillable VA Form 10-5548A for registration and ongoing surveillance through the VA National Cardiac Device Surveillance Program (NCDSP). This form supports remote telephone follow-up and registry maintenance.
Download VA Form 10-5548A Fillable PDF
What Is VA Form 10-5548A?
VA Form 10-5548A (August 2007) is the official Pacemaker Surveillance Registry and Revision form used by the Department of Veterans Affairs. It facilitates patient registration, updates, and follow-up data for Veterans with cardiac pacemakers. The form is submitted to VA Pacemaker Surveillance Centers for monitoring device function, battery status, and patient outcomes.
Purpose of the Pacemaker Surveillance Form
The form supports the VA’s National Cardiac Device Surveillance Program by enabling:
- Initial patient registration in the pacemaker registry
- Reporting of pacemaker implants, replacements, revisions, or explants
- Telephone follow-up data submission for remote monitoring
- Tracking of pacing malfunctions, battery status, and clinical measurements
- Registry updates for patient transfers, deaths, or data changes
This centralized system helps ensure timely intervention for device issues and supports responses to FDA recalls.
Who Should Use VA Form 10-5548A?
VA healthcare providers at local VAMCs complete Part I and mail the form to the appropriate surveillance center. It is primarily for:
- Veterans with implanted pacemakers receiving care through VA
- VA clinicians managing cardiac device patients
- Patients enrolled in or referred to the Eastern or Western Pacemaker Surveillance Centers
The program monitors thousands of Veterans through telephonic ECG transmissions and remote monitoring.
How to Download and Complete the Fillable VA Form 10-5548A?
- Download the official fillable PDF: VA Form 10-5548A Fillable
- Open in Adobe Acrobat Reader (recommended for fillable fields)
- Complete Part I for registry actions (implant, replacement, etc.)
- Provide detailed patient information, device specifications, and clinical data in Part II for follow-ups
- Submit to the appropriate center:
- Eastern Pacemaker Surveillance Center: 50 Irving Street, N.W., Washington, D.C. 20422
- Western Pacemaker Surveillance Center: 4150 Clement Street, San Francisco, CA 94121
Key Sections of VA Form 10-5548A
| Section | Details |
|---|---|
| Part I | Patient registration, death, transfer, implant/replacement/revision details |
| Patient Information | Name, DOB, SSN, contact info, referring VAMC |
| Pulse Generator & Leads | Model, serial numbers, implant dates, manufacturer |
| Part II | Follow-up data: thresholds, programmed settings, clinic measurements, pacing indications |
| Pacing Mode & Indications | AAI, VVI, DDD, etc., and detailed EKG/pacing history |
VA Pacemaker Monitoring Benefits for Veterans
Participation in the VA National Cardiac Device Surveillance Program provides:
- Remote telephone and web-based monitoring
- Early detection of battery depletion or device issues
- Support during FDA recalls or safety alerts
- Coordinated care between local VAMCs and specialized centers
Veterans with pacemakers may also qualify for VA disability ratings under diagnostic code 7018.
Related VA Resources for Pacemaker Patients
- VHA Directive 1189: National Cardiac Device Surveillance Program
- Veterans Health Library – Pacemaker Information
- VA Health Care Benefits
Frequently Asked Questions (FAQs)
Is VA Form 10-5548A still current?
Yes, the August 2007 version remains the official form referenced on the VA forms portal for pacemaker surveillance.
Do I need to submit this form myself as a Veteran?
Typically, your VA healthcare provider or cardiologist completes and submits the form as part of your care coordination.
What if I have questions about my pacemaker monitoring?
Contact your local VA Medical Center or the appropriate Pacemaker Surveillance Center for assistance.
Conclusion
VA Form 10-5548A is a critical tool ensuring Veterans with pacemakers receive consistent, high-quality surveillance through the VA’s specialized program. Proper use of this fillable form helps maintain device safety and supports optimal heart health management.
Official Download: Click here to download VA Form 10-5548A (Fillable PDF)