Exceptional Case Interruption to Care

This form is used to notify the Department of Veterans’ Affairs (DVA) of an interruption to a client’s care. This form must be completed by a Registered Nurse (RN) and submitted within seven (7) days after the interruption has occurred.

If you are using an Apple computer and want to fill out your form electronically, please download the form and open it with Acrobat 7 or later.