va office identification nos. (c,xc,ss,xss,v,k, etc ... - wwlp

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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REPORT OF CONTACT




VA OFFICE

VA Central Western

Massachusetts



DATE OF CONTACT

16 JAN 18

ADDRESS OF VETERAN


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


18-05500-F002

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REPORT OF CONTACT




VA OFFICE

VA Central Western

Massachusetts


LAST NAME-FIRST NAME-MIDDLE NAME OF VETERAN (Type or print) DATE OF CONTACT

06 SEP 17

ADDRESS OF VETERAN


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


18-05500-F003

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REPORT OF CONTACT




VA OFFICE

VA Central Western

Massachusetts



DATE OF CONTACT

14 JUL 17

ADDRESS OF VETERAN


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


18-05500-F004

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REPORT OF CONTACT




VA OFFICE

VA Central Western

Massachusetts



DATE OF CONTACT

23 JAN 18

ADDRESS OF VETERAN


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


18-05500-F005

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REPORT OF CONTACT




VA OFFICE

VA Central Western

Massachusetts



DATE OF CONTACT

13 JUL 17

ADDRESS OF VETERAN


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


18-05500-F006

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REPORT OF CONTACT




VA OFFICE

VA Central Western

Massachusetts



DATE OF CONTACT

24 JUL 17

ADDRESS OF VETERAN


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


18-05500-F007

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REPORT OF CONTACT




VA OFFICE

VA Central Western

Massachusetts



DATE OF CONTACT

31 OCT 17

ADDRESS OF VETERAN


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.


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


18-05500-F008

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REPORT OF CONTACT




VA OFFICE

VA Central Western

Massachusetts



DATE OF CONTACT

29 SEP 17

ADDRESS OF VETERAN


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


18-05500-F009

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REPORT OF CONTACT




VA OFFICE

VA Central Western

Massachusetts



DATE OF CONTACT

ADDRESS OF VETERAN


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.


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


18-05500-F010

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va office identification nos. (c,xc,ss,xss,v,k, etc ... - wwlp

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