Fillable VA2345 VA Form 2345, VETERAN'S REQUEST FOR PROSTHETIC SOCKS

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VA2345 VA Form 2345, VETERAN'S REQUEST FOR PROSTHETIC SOCKS

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The VA2345 VA Form 2345, VETERAN'S REQUEST FOR PROSTHETIC SOCKS form is 1 page long and contains:

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Country of origin: US
File type: PDF

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PRINT FORM AND MAIL TO:
DEPARTMENT OF VETERANS AFFAIRS
Denver Acquisition & Logistics Center (003A4D)
P.O. Box 25166
Denver CO 80225-0166
For additional information, visit: https://www.va.gov/opal/nac/dlc/socks.asp.
PRINT LAST NAME - FIRST NAME - MIDDLE INITIAL
SOCIAL SECURITY NO.
(Last four digits)
MAILING ADDRESS (Street, City, State and ZIP Code)
THIS ADDRESS IS:
NEW
PERMANENT
TEMPORARY
DATE OF REQUEST
ITEM REQUESTED
1. SOCK SIZE NO.
LEG
RIGHT LEFT
ARM
RIGHT LEFT
MEASUREMENT
WIDTH AT TOP
MEASUREMENT
WIDTH AT TOE
MEASUREMENT
LENGTH
MATERIAL AND PLY
2. SHEATH SIZE
3. T-SHIRT, COTTON (for shoulder disarticulation), SIZE:
REMARKS
VA FORM
NOV 2012
2345
VETERAN'S REQUEST FOR PROSTHETIC SOCKS
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VA2345 VA Form 2345, VETERAN'S REQUEST FOR PROSTHETIC SOCKS

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Completed 10 July 2020

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