Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)
DATE OF CONTACT
13 OCT 17
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN: Task # T18-0146 - VA IQ Assignment--Parent Workflow ID
7845600/
Veteran’s Inquiry: stated he is a Vietnam Veteran, receives his care at the Springfield Clinic, and has the following
compliments:
1. He stated he had been treated with the utmost respect and professionalism by
2. He stated researched, planned and executed the most effective treatment for he has ever had.
completely pain free, and his quality of life has never been better.
3. He stated he wanted to ensure received these compliments.
Actions Taken: I reached by phone on 13 OCT 17, and informed him I was calling regarding his compliments that were
reviewed by the White House, then referred to the Central Western Massachusetts VA for a response. I provided my
name and contact number as a Point Of Contact for the future.
1. stated he was very pleased with , and all his care providers at the Springfield Clinic. He said everytime
he goes for an appointment, everyone is friendly, provides great care, and fully explains follow on actions and appointments.
2. stated he has been receiving care at the VA CWM facilities for over twenty years, and the care today is better
than it has ever been. He said he loved the VA Healthcare System, and would not go anywhere else.
3. I ensured I would pass his compliments to the Springfield Clinic, specifically .
was very pleased with our phone conversation, customer service, and the fact that his compliments were received and
acted upon. I will continue to maintain communications with , and will assist him with any future issues to ensure he has
continues to have positive experiences in the VA Healthcare System.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F001
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Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)
DATE OF CONTACT
16 JAN 18
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
(
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN: Task # T18-0447 - WHH SF 24690 Access & Timeliness -
Priority Request
Veteran’s Inquiry: stated he had the following complaints:
1. The Veteran contacted the WHH and stated he is upset because when he went to the Audiology Department at the CWM VA, he
was told he has to make an appointment to check the batteries in his hearing aids. The Veteran stated he can go to the
, and that facility has a walk in hearing clinic. Veteran stated the CWM VA does not meet his needs,
and waited for 2 weeks to get an appointment.
Actions Taken: I reached by phone on 16 JAN 18, and informed him I was calling regarding his complaint that was reviewed
by the White House, then referred to the Central Western Massachusetts VA for a response. I provided my name and phone
number as a Point Of Contact for the future.
1. On 16 OCT 17, I explained to that our Audiology Department will always assist with battery replacement and minor
repairs to hearing aids on a walk-in basis. I informed him that he was correct that there is not a walk-in clinic due to manpower
and space, but Veterans come in all the time when they need batteries or parts replaced, and it has never been an issue. I
reassured him he should never hesitate to visit if he is having any issues with his hearing aids.
2. was actually pleased that he got an appointment in two weeks. He said in that regards, the VA CWM has always met
his needs, and he has no other issues to voice.
was very pleased with our phone conversation, customer service, and the fact that all of his issues and concerns were
addressed. I will continue to maintain communications with , and will assist him with any future issues to ensure he
has positive experiences as he continues navigating the VA Healthcare System.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F002
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Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print) DATE OF CONTACT
06 SEP 17
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN: Task # T17-1008; VA 60700 WH Coordination of Care
Veteran’s Inquiry: stated she is a Veteran, and the widow of a retired Air Force Veteran.
1. She would like the hotline’s assistance in securing health care services to determine what condition she has in her and what
treatment plan should be used. She has been seen by many doctors since the American Legion encouraged her to start utilizing VA
services in 1994. She has had numerous tests, but there have been no diagnosis’ other than . She believes her condition is
much worse; it has been difficult for her to stand, sit or walk since 1965, and the symptoms have worsened over time.
2. She would like a VA specialist to contact her regarding Aid and Attendance that may be available under her coverage or her
husband’s. She stated she is 70 years old, and has difficulty given her physical condition.
3. She would like a VA specialist to contact her regarding her level of benefits which she believes is much lower than what she
should be receiving. She was told she could not receive 50% of her husband’s benefits because she was 2 months shy of being married
20 years.
4. She would like a VA specialist to contact her regarding burial benefits.
Actions Taken: I reached by phone on 06 SEP 17, and informed her I was calling regarding her phone call that was
reviewd by the White House, then referred to the Central Western Massachusetts VA for a response. We arranged a meeting, a Primary
Care Dr.’s appointment, and a video teleconference with the Boston VBA on 12 SEP 17 to discuss her complaint and seek resolution. I
provided my name and contact number as a Point Of Contact for the future.
1. I explained to that I was the Director’s representative, and my position exists to ensure she and all Veterans have
good experiences with their health care, and also to address and resolve Veterans’ issues. understood, and was assured we
were making all attempts to satisfy her needs. I arranged an appointment with her PCP, , on 12 SEP 17 to evaluate, and begin
treatment for her issues. I explained to she had to start with her PCP to get follow on care either in
or through the Choice Program. Additionally, I will attend the appointment with at her request.
2. and I then discussed Aid and Attendance, her current disability percentage, and also issues regarding her
husband’s benefits. I explained to her the process for getting additional information regarding all these, and also coordinated with the
Boston VBA for a video teleconference on 12 SEP 17 prior to her PCP appointment. understands these are issues the VBA
can assist with, but did not understand the processes to resolve them. I will attend the video teleconference with to ensure
all her VBA issues are addressed, and will also guide her through the appeal and any other processes.
3. Lastly, and I discussed Burial Benefits. She stated she was computer literate, so I talked her through the VA.and
National Cemetary Administration websites to educate her on Burial Benefits. Additionally, we discussed Massachusetts State Burial
Benefits, and I guided her through that information also.
was very pleased with our phone conversation, and is looking forward to 12 SEP 17 to begin resolving her issues. I will
continue to maintain communications with , attend her PCP appointment, and participate in the video teleconference with
the VBA. Also, I will assist her with any future issues to ensure she has positive experiences as she continues receiving benefits from the
VA.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F003
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Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)
DATE OF CONTACT
14 JUL 17
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN
Task #: T17-0808; ExecVA 56102 WH - VHA Decisions and Preference - New Patient Appt
Veteran’s Inquiry: stated he is experiencing difficulty making appointments to check on him at the Pittsfield, MA,
CBOC, and also eligibility / use of the Choice Program since 5 JUN 17 for this check. went to the CBOC for blood tests and,
was told he would need to see a doctor because he had not been seen at the clinic in over four years. Additionally, he was told he would
be considered a “new” patient since he had not been seen in the past year. An appointment was scheduled for 7 SEP 17, and
was informed he could submit a request for the Choice Program since he could not be seen within 30 days. primary care
doctor is who was on vacation at the time. Initially, was told since he was a new patient, he would not
qualify for Choice. contacted Choice and was told they did not have a referral for him, and that it takes 7-10 days to get a
referral from the clinic. called back after nine days to Choice, and they still had not received a referral. then
called the CBOC, and told him there was no money in Choice, and since was determined to be a new patien, he was not
eligible. called the VA 1-800 number and verified he has been a patient for the last ten years. then called Choice
and was informed there has always been money in the program. informed money was only available for
mammograms and colonoscopies. called Choice to verify this information, and was told that was misinformation and not true.
requested a copy of the information he was being told by the CBOC, and was informed to contact the Patient Experience
Coordinator, . received a phone call from that she had scheduled an appointment through for an
appointment on 1 AUG 17. confirmed the new appointment, and cancelled his previous appointment 7 SEP 17.
said when he spoke with the PEC, he specifically requested his appointment for the 7 SEP 17 not be cancelled. is concerned
he is being misinformed by VA personnel, and not being able to get an appointment through the Choice program.
Actions Taken: I reached by phone on 14 JUL 17, and advised him I was calling regarding his information that was reviewd
by the White House, then referred to Central Western Massachusetts for a response. Also, I provided my name and direct
contact number as a Point Of Contact for future issues.
I informed the following:
1) I informed him he was never considered a “new” patient. The reason he had to be seen by his doctor for a scheduled hour was
because he had not been seen in the CBOC since 2014. The appointment was to check his overall health, and determine if he had any
additional issues. He completely understood this, and agreed it was a good requirement.
2) and I then discussed the Choice Program. I explained if he could not be seen in 30 days within the VA system,
he would be referred to Choice. I also explained to him the 40 mile Choice caveat did not apply in his case, or any other veteran’s in
Massachusetts due to the locations of our facilities. He understands the Choice Program is not an option, but is displeased he received
conflicting information since JUN 17. I explained the program was changing during that time, and apologized he felt misinformed.
3) I confirmed upcoming appointments: on 19 JUL 17; on 7 SEP 17. The CBOC and I ensured
his 7 SEP 17 appointment was not cancelled.
was satisfied with the answers provided, but still frustrated with the Choice Program. I will continue to maintain
communications with , and assist him with any additional issues to ensure he has a positive experience as he continues
navigating the VA Health Care system.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F004
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Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)
DATE OF CONTACT
23 JAN 18
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN: Task # T18-0446 - WHH SF 22885 - Healthcare Concerns
Veteran’s Inquiry: stated she had the following complaints:
The Veteran contacted the WHH and stated she was having a major medical issue that is not getting taken care of. She has gone to the ER
multiple times and they gave her meds to help her for a bit but still nothing else is being done by her doctor. Veteran fears for her life and
wants her problem corrected. She has had this issue since January of 2017. Veteran is requesting to see a doctor about
her issue.
1. The Veteran is upset because she has gone to the Urgent care and Emergency Room multiple times for her issues, and feels she is
not being given the attention needed. Additionally, she stated she is everytime she sits down, has constant
pain, and ultimately fears for her life.
Actions Taken: I reached by phone on 23 JAN 18, and informed her I was calling regarding her complaint that was
reviewed by the White House, then referred to the Central Western Massachusetts VA for a response. I provided my
name and phone number as a Point Of Contact for the future.
1. On 23 JAN 18, I spoke to . She was referred to a , and had an appointment on 18 JAN 18.
Additionally, she has a follow up appointment on 15 FEB 18 for .
2. was very pleased with the swiftness of actions taken to meet her medical requirements. She said in that regards,
the VA CWM has always met her needs, and she has no other issues to voice.
was very pleased with our phone conversation, customer service, and the fact that all of her issues and concerns
were addressed. I will continue to maintain communications with , and will assist her with any future issues to
ensure she has positive experiences while continuing to navigate the VA Healthcare System.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F005
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Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)
DATE OF CONTACT
13 JUL 17
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN
Task #: T17-0795; VA IQ Assignment--Parent Workflow ID 7811593
Veteran’s Inquiry:
- letter stated the following: “I apologize for troubling you and your staff again. In my last letter the
response is not what I thought it should be. You sent the letter that I wrote to the VA Hospital that I had past problems with. That was
not the intension I had in mind. I just wanted your office to examine the problems and hopefully address them for all Vets, not the
individual Hospitals. The VA did contact me and told me all the things I already knew…Now I would appreciate asking a direct question
to you or your staff and hopefully you will answer me directly…I have a and I was told the only people that could help me
because of my location was in , MA, or It takes me approximately 2 hrs travel to any
of these locations. Will I qualify for outside medical service? If not why?”
Actions Taken: I reached by phone on 13 JUL 17, and advised him I was calling regarding his letter that was reviewd by
the White House, then referred to Central Western Massachusetts for a response. Also, I provided my name and direct
contact number as a Point Of Contact for future issues.
I informed the following:
1) I informed him when a complaint is sent to the national level, it will be forwarded to the local servicing facility to answer and fix
the issue. He completely understood this, and agreed that is the best way to fix veteran’s issues.
2) and I then discussed his options for future heart health care. He understands the Choice Program is not an option
in his specific case, and the best treatment he can be provided within VA parameters is in , MA, or
. He stated he will be going to , and has two upcoming appointmentments.
3) added he called the Clinic because he had , and ultimately was turned away. I informed
him many of the clinics in the area do not have the capabilities required to treat emergency and other conditions. Because
of that, the recommended a local hospital so he could get the best care possible.
was satisfied with the answers provided. I will continue to maintain communications with and assist him
with any additional issues to ensure he has a positive experience as he continues navigating the VA Health Care system.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F006
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Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)
DATE OF CONTACT
24 JUL 17
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN: Task # T17-0835; VHA ExecVA 50650 - Staff Courtesy
Veteran’s Inquiry: Veteran called the VHA Office of Client Relations to complain about the Northampton call center, and complain about
treatment at the Springfield, MA outpatient clinic. Issue Summary (disability benefits/healthcare/other):
1. Local VA advocate and director have not been able to help.
2. Nurse was rude and nasty, and stated she could not assist him.
3. Spoke with clinic supervisor, and supervisor sided with nurse.
4. Was told if he did not want to be seen by nurse anymore, he would have to find a new primary care doctor.
5. Call Center in Northampton hung up on him when he called to complain.
6. When he called patient advocate in Northampton, they responded by saying they do not know what to do.
Actions Taken: I reached by phone on 19 JUL 17, and advised him I was calling regarding his phone call that was reviewd
by the White House, then referred to the Central Western Massachusetts VA for a response. We arranged a meeting on 24 JUL 17 to
discuss his complaint and seek resolution. I provided my name and contact number as a Point Of Contact for the future.
On 24 JUL 17, , and I met at the Springfield CBOC. We discussed the following:
1. I explained to that I was the Director’s representative, and my position exists to ensure he and all Veterans have
good experiences with their health care, and also to address and resolve Veterans’ issues. understood, and was assured by
we were making all attempts to satisfy his needs.
2. discussed in depth his experience on 8 JUN 17. He perceived the nurse was belittling and badgering him due to the
fact he did not arrive 15 minutes prior to his appointment. Following the third time he was told he must arrive 15 minutes early, .
left the treatment area, went to the front desk, and demanded to speak to the supervisor. engaged , and
told her he wanted the nurse removed from the PACT so he could continue to see . offered him a transfer to another
team, which he declined. explained to the team would not be changed, and due to limited staffing, he might see
the same nurse in the future. At that point, departed the clinic.
3. During our meeting, discussed some of the has, and is currently being treated for.
agreed that these issues may have caused to perceive this engagement with the nurse in a
negative way. agreed he may have been anxious and stressed, but still believes he was disrespected by the nurse, and she
should be verbally councelled or reprimanded. and I explained the PACT Team concept, and why recommended
another team. understood this, and has been assisgned to PACT 9. is satisfied with this change.
4. Lastly, stated the Northampton call center hung up on him multiple times when he tried to explain his situation. We
discussed when he called and stated he could not scream at the operators, and since he did, they had to hang up to address other patients
calls. I again reiterated he should call me in the future with any issues, and we would address and resolve the problem(s). He understood
this, and was satisfied we could continue to help him.
was satisfied with our meeting, but still frustrated with his perceived treatment at the Springfield Clinic. I will continue to
maintain communications with , and assist him with any additional issues to ensure he has a positive experience as he
continues receiving health care at the Springfield CBOC.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F007
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Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)
DATE OF CONTACT
31 OCT 17
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN: Task # T18-0212 - ExecVA 63097 Medication
Veteran’s Inquiry: stated he is a Vietnam Veteran, and had the following complaints:
1. The Veteran contacted the WHH and stated he is allergic to his Medication, and his doctor does not want to
change it. He has spoken to someone in the office about the issues. He also feels that the VA system gives him the run around.
Actions Taken: I reached by phone on 31 OCT 17, and informed him I was calling regarding his complaint that was reviewed
by the White House, then referred to the Central Western Massachusetts VA for a response. I provided my name and contact
number as a Point Of Contact for the future, and told him I will follow up with him on 10 NOV 17.
1. On 16 OCT 17, I attended PCP appointment with him at the Springfield Community-Based Outpatient Clinic.
explained to the issues he was having with his Medication. immediately
wrote him a prescription for a different medication, and told she would call him within 2-3 days to see if he was
having any issues. The appointment went well, and was extremely attentive to needs.
2. During phone contact on 31 OCT 17, stated his current Medication was working well, and overall he
felt much better. Also, he asked if he could do a “formal compliment” for , and I told him I would pass that
compliment to her, the PACT and our Chief of Staff.
was very pleased with our phone conversation, customer service, and the fact that all of his issues and concerns were
addressed. On 10 NOV 17, I am meeting with and Occupational Therapy to assist him with his request for a scooter. I
will continue to maintain communications with , and will assist him with any future issues to ensure he has positive
experiences as he continues navigating the VA Healthcare System.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F008
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Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)
DATE OF CONTACT
29 SEP 17
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN: Task # T17-1068 - VA IQ Assignment - Parent Workflow ID
7836989
Veteran’s Inquiry: stated he is a Vietnam Veteran, and requested additional information regarding benefits.
1. He stated he had difficulty driving from the Pittsfield Clinic where he receives treatment, and , where he resides,
due to combat related and other health issues. 2. He stated he was concerned about changes in the National Healthcare System affecting his VA Healthcare. informed
me he is a 100%, permananent and total, disabled Veteran. 3. He asked if there were any options for VA Healthcare outside the clinic, specifically services he could receive at his home.
Actions Taken: I reached by phone on 29 SEP 17, and informed him I was calling regarding his letter that was reviewd by the
White House, then referred to the Central Western Massachusetts VA for a response. I provided my name and contact number
as a Point Of Contact for the future, and told him I will follow up with him on 11 OCT 17.
1. I explained to that we could assist with his transportation to the Leeds Campus as required through our shuttle from
the Pittsfield Clinic. Also, based on his disability rating, he could take a cab or public transportation, and be reimbursed through
our travel office. Lastly, I informed him I would assist with lining up DAV, and other benevolent organizations’ travel resources
to assist.
2. I explained to his benefits would not change, and if anything, may expand due to his disability rating. After our
discussion, he understood the VA Healthcare System is not directly tied to our Nations’ current debate on healthcare, and
possible changes in the future.
3. Lastly, and I discussed VA Healthcare options outside the clinic, specifically services he may receive at his home. I
explained the Geriatrics and Extended Care mission, and also how we take care of Veterans through Home Based Care. He had
not heard of these benefits, and was very excited to gather additional information. Lastly, I coordinated for our Geriatrics and
Extended Care and Home Based Care representaives to call , and this was completed at 1500 on 29 SEP 17.
was very pleased with our phone conversation, customer service, and all of his issues and concerns were addressed. I will
continue to maintain communications with , and will assist him with any future issues to ensure he has positive experiences as
he continues receiving benefits from the VA.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F009
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Automated VA Form 119
REPORT OF CONTACT
NOTE: This form must be filled out in ink
or on typewriter as it becomes a permanent
record in veterans' folders.
VA OFFICE
VA Central Western
Massachusetts
IDENTIFICATION NOS. (C,XC,SS,XSS,V,K, etc.)
LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print)
DATE OF CONTACT
ADDRESS OF VETERAN
TELEPHONE NO. OF VETERAN
PERSON CONTACTED
TYPE OF CONTACT (Check)
TELEPHONE ADDRESS OF PERSON CONTACTED
TELEPHONE NO. OF PERSON CONTACTED
BRIEF STATEMENT OF INFORMATION REQUESTED AND GIVEN: Task # T18-0091 - ExecVA 63097
Veteran’s Inquiry: stated he is a Vietnam Veteran, and had the following complaints:
1. He stated he had been treated rudely by the front desk and pharmacy employees. He said the front desk employee did not listen
to him, and the pharmacy employee questioned his prescriptions that were approved by his Doctor. Additionaly, he complained
the pharmacy employee questioned the ID Card(s) he presented when filling his prescriptions.
2. He stated he would like to compliment his PCP, and said she was very professional and thorough.
Actions Taken: I reached by phone on 04 OCT 17, and informed him I was calling regarding his complaint that was reviewed
by the White House, then referred to the Central Western Massachusetts VA for a response. I provided my name and contact
number as a Point Of Contact for the future, and told him I will follow up with him on 10 OCT 17.
1. I explained to that I spoke to the Nurse Manager of the Springfield CBOC, and requested she reinforce to the entire
Staff that we must treat Veterans with respect and empathy throughout their experiences. The Nurse Manager said she would
talk to the entire Staff, and specifically focus on the employees at the Front Desk and in the Pharmacy. Also, I was informed by
that his wallet was stolen, and the only ID he had was very badly damaged. The pharmacy positively identified
after reviewing the badly damaged ID Card and his medical file, then filled his prescriptions with no further incidents.
2. I stated to that we appreciated his compliment for his PCP, and I would pass that compliment to her,
the PACT and our Chief of Staff.
was very pleased with our phone conversation, customer service, and the fact that all of his issues and concerns were
addressed. On 10 OCT 17, I am meeting with and the DAV Representative to assist him with his claim for Aid and
Attendance, and also for the Clothing Allowance. Following this meeting, we will conduct a Teleconference with the Regional Office to
assist with any additional benefits may be eligible for. I will continue to maintain communications with , and will
assist him with any future issues to ensure he has positive experiences as he continues navigating the VA Systemreceiving benefits from
the VA.
DIVISION OR SECTION
631 EXECUTED BY (Signature and Title)
18-05500-F010
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