VA Form 10-2649A: Inter-Facility Transfer Form Download – Veterans enrolled in VA health care may need to transfer between facilities for specialized treatment, higher-level care, or other medical reasons. VA Form 10-2649A, the official Inter-Facility Transfer Form, standardizes this process to ensure patient safety, continuity of care, and compliance with VA policies.
This comprehensive guide explains everything U.S. veterans and their families need to know about the form, including its purpose, how it’s used, required sections, and how to access the latest version.
What Is VA Form 10-2649A?
VA Form 10-2649A is the Inter-Facility Transfer Form used by the Department of Veterans Affairs (VA). It must be completed for every transfer request to and from a VA medical facility.
The current revision date is September 2025. It supports both routine and emergent transfers, with provisions allowing completion after transfer if immediate patient care takes priority.
This form works alongside VA Form 10-2649B (Provider Certification and Patient Consent for Transfer) and is part of VHA Directive 1094 on Inter-Facility Transfer Policy.
Why Veterans Need the Inter-Facility Transfer Form?
The form ensures safe, well-documented transfers by capturing:
- Patient demographics and clinical status
- Reasons for transfer
- Accepting and referring facility details
- Infection control information
- Medication, allergies, and support needs during transfer
It promotes continuity of care, helps receiving facilities prepare, and supports quality monitoring across the VA system. Transfers occur for reasons such as unavailable services at the referring facility, patient request, or need for specialized care.
Key benefits:
- Improves patient safety during transitions
- Documents risks, benefits, and consent
- Facilitates communication between facilities
- Supports compliance with EMTALA-like principles for emergency transfers
Key Sections of VA Form 10-2649A
The fillable PDF includes several structured sections:
Section I – Demographic Information
Includes patient name, SSN, address, contact info, age, and resuscitation status (e.g., Full Code, DNR, or mechanical ventilation preferences).
Section II – Reason for Transfer
Common options include:
- Service not available at referring facility
- No bed available
- Patient/family request
- Involuntary mental health hold
- Nursing facility transfer
- State of emergency
It also requires a clinical summary and description of needed services.
Section III – Transfer Information
Details current and accepting locations, clinicians, dates, level of care (ED, Ward, Stepdown, ICU), and transportation mode (e.g., BLS, ALS, Critical Care). It specifies support needs like oxygen, IV medications, monitors, or restraints.
Section IV – Infection Control Information
Critical for safety: isolation status, history of MRSA, VRE, C. diff, CRE, ESBL, or other epidemiologically significant organisms.
Section V – Medication and Vaccine Information
Lists allergies, active medications, immunizations, and instructions for documents to send with the veteran (e.g., discharge summary, nurse handoff, portable orders).
Physician certification confirms that benefits of transfer outweigh risks.
How to Fill Out and Use VA Form 10-2649A?
- Who completes it? Primarily VA clinical and administrative staff at the referring facility. A physician must certify the transfer.
- Process — Notify the receiving facility, confirm acceptance, complete the form (or use a CPRS template), gather supporting documents, and arrange transportation.
- Emergent cases — The form can be completed post-transfer if needed for immediate care.
- Sending documents — Always include the completed form, relevant notes, summaries, and portable orders.
For non-VA to VA transfers, equivalent information may be accepted in some cases.
Pro Tip: Veterans and families should communicate clearly with care teams about transfer needs and ask questions about the process.
Download VA Form 10-2649A (Official Fillable PDF)
Access the most current version directly from the VA:
Download VA Form 10-2649A (PDF)
This is the official fillable form from va.gov. Always use the latest revision for compliance.
Related Resource: VA Form 10-2649A Information Page
VA Inter-Facility Transfer Policy Overview
VHA Directive 1094 governs these transfers, emphasizing:
- Patient safety and stabilization before transfer
- Physician approval
- Appropriate transportation
- Quality monitoring of all transfers
The directive applies to both VA-to-VA and VA/non-VA transfers.
Common Questions About VA Form 10-2649A
Who uses this form?
VA physicians, nurses, and administrative staff handling patient transfers between VA medical centers, hospitals, or clinics.
Is it only for emergencies?
No. It covers all transfers, including planned moves for specialty care.
What if the veteran refuses transfer?
Separate processes and forms (like VA Form 10-8001) may apply for refusals.
Can veterans access the form themselves?
Yes, for review or records, but clinical staff typically complete it during the transfer process.
Tips for a Smooth VA Facility Transfer
- Keep a list of current medications, allergies, and advance directives ready
- Confirm insurance/VA eligibility details
- Ask about transportation options (VA may coordinate)
- Follow up with both facilities to ensure records transferred successfully
- Contact your VA Patient Advocate if issues arise
For personalized assistance, reach out to your local VA health care facility or call the VA Health Care hotline at 877-222-8387.
Stay informed with official VA resources and consult your care team for specific transfer situations. This form plays a vital role in delivering coordinated, high-quality care to veterans across the country.
This article is for informational purposes only and is based on publicly available VA resources as of 2026. Always verify the latest forms and policies directly on va.gov.