VA Form 10-0376a: Credentials Transfer Brief Guide (2026)

VA Form 10-0376a: Credentials Transfer Brief Guide (2026) – VA Form 10-0376a, officially titled the Credentials Transfer Brief, streamlines the transfer of professional credentials for healthcare providers moving between VA medical facilities. This form is essential for physicians, dentists, and other licensed clinicians within the Veterans Health Administration (VHA) system.

What Is VA Form 10-0376a?

VA Form 10-0376a is a standardized document used by the Department of Veterans Affairs to transfer verified credentialing information from one VA facility to another. It summarizes a provider’s education, training, licenses, certifications, and clinical privileges.

The form supports efficient internal transfers while maintaining high standards for patient safety and compliance. It was last revised in July 2005, and existing stock of earlier versions remains acceptable.

Official Download Link:
Download VA Form 10-0376a (PDF) from VA.gov

Who Needs to Use VA Form 10-0376a?

This form primarily serves VA-employed or transferring healthcare professionals, including:

  • Physicians
  • Dentists
  • Other licensed providers seeking inter-facility transfers within the VA system

It is not typically for initial hires (which often use forms like VA Form 10-2850) but for credential portability when moving between VA locations.

VA facilities use it to quickly verify a provider’s qualifications without repeating full primary source verifications.

Purpose and Importance of the Credentials Transfer Brief

The main purpose is to facilitate seamless sharing of credentialing data, including:

  • Education and training history
  • State medical licenses
  • Board certifications
  • Life support certifications (BCLS, ACLS)
  • Clinical privileges
  • National Practitioner Data Bank (NPDB) information

This supports efficient staffing, reduces administrative delays, and ensures continuity of care for Veterans across VA facilities.

Key Benefits:

  • Speeds up the privileging process at the receiving facility
  • Reduces redundant paperwork
  • Maintains compliance with VA policies and federal regulations (Title 38 U.S.C.)

Key Sections of VA Form 10-0376a

The two-page form includes detailed fields:

  1. Identifying Data — Name, SSN, type of appointment, specialty.
  2. Education and Training — Medical school, internship, residency, fellowship with verification status.
  3. ECFMG (for international graduates).
  4. State Medical License — Details, expiration, and verification.
  5. Controlled Substance Registration (CDS).
  6. Specialty Board Certification and subspecialties.
  7. Life Support Certifications (BCLS/ACLS).
  8. Clinical Privileges granted at the current facility.
  9. NPDB Query history.
  10. Clinical Summary — Attestations from service chiefs regarding competence.
  11. Signatures from the medical staff coordinator at the providing facility.

The form emphasizes primary source verification and includes privacy act notices.

How to Fill Out and Submit VA Form 10-0376a?

Steps for Providers and Facilities:

  • The current (providing) VA facility’s credentialing office typically completes the form.
  • Gather all supporting documents from the provider’s credentialing file.
  • Verify information against primary sources where noted.
  • Obtain required signatures and attestations.
  • Send the completed form (with attachments if needed) to the receiving VA medical center.

Providers may need to assist by confirming details or providing updates. Always use the official fillable PDF for accuracy.

Tip: Contact the credentialing office at both facilities for specific submission procedures, as processes can vary slightly by location.

VA Form 10-0376a is part of a broader credentialing and privileging system. Providers transferring may also interact with:

  • Ongoing monitoring and re-credentialing
  • NPDB Continuous Query enrollment
  • State licensing requirements (VA providers must maintain active licenses)

For new applicants, other forms like the 10-2850 series are more appropriate.

Common Questions About VA Form 10-0376a

Is the form still current?
Yes. The July 2005 version is the official one listed on VA.gov.

Can I submit it electronically?
Facilities often handle secure internal transfers. Check with your VA credentialing coordinator.

What if information changes after submission?
Notify both facilities promptly, as credential status must remain accurate.

Why Proper Credential Transfer Matters for VA Providers?

Efficient use of VA Form 10-0376a helps address staffing needs at VA facilities nationwide, ultimately improving care for America’s Veterans. Delays in credentialing can impact hiring and transfers, so understanding this form is valuable for VA healthcare professionals.

For the most accurate and up-to-date guidance, always refer to official VA resources or consult your local VA Medical Center’s credentialing and privileging office.

Official Resource:
VA Form 10-0376a Information Page on VA.gov

This article is for informational purposes only and is not a substitute for official VA guidance or legal advice.