Official VA Form

VA Form 10-7959A

CHAMPVA Claim Form

VA Form 10-7959A — CHAMPVA Claim Form is an official U.S. Department of Veterans Affairs form used for health care. The current version was last revised 2013-08-20. It is 2 pages long. Download the up-to-date PDF below — BaseNeed syncs form data directly from VA.gov so you always get the current edition.

Download the official PDF (VA.gov) →

Last revised: 2013-08-20
First issued: 2022-10-20
Pages: 2
Administered by: VHA

Health care

Frequently asked questions

What is VA Form 10-7959A used for?

CHAMPVA Claim Form. It is an official VA form in the Health care category, administered by VHA.

Where can I download the current VA Form 10-7959A?

Download the official PDF from VA.gov here: https://www.va.gov/vaforms/medical/pdf/vha-10-7959a-fill.pdf (last revised 2013-08-20).

How long is VA Form 10-7959A?

VA Form 10-7959A is 2 pages long, last revised 2013-08-20.

Always the current version — synced from VA.gov. BaseNeed is not affiliated with the U.S. Department of Veterans Affairs.

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More Health care forms

VA Form 10-3542 — Veteran/Beneficiary Claim for Reimbursement of Travel Expenses
VA Form 10-7959C — CHAMPVA—Other Health Insurance (OHI) Certification
VA Form 10-10EZ — Instructions and Enrollment Application for Health Benefits
VA Form 21-4142a — General Release for Medical Provider Information to the Department of Veterans Affairs
VA Form 21-0845 — Authorization to Disclose Personal Information to a Third Party
VA Form 10-0137 — VA Advance Directive: Durable Power of Attorney for Health Care and Living Will
VA Form 21-4142 — Authorization to Disclose Information to the Department of Veterans Affairs (VA)
VA Form 21P-8416 — Medical Expense Report

Nearby form numbers

VA Form 10-7174 — Measurement Form - Elastic Hosiery
VA Form 10-7396b — Complications of Surgical Procedures - Continuation Sheet
VA Form 10-7919 — Request For Library Materials
VA Form 10-7959C — CHAMPVA—Other Health Insurance (OHI) Certification
VA Form 10-7959D — CHAMPVA Potential Liability Claim
VA Form 10-7959E — Claim for Miscellaneous Expenses