Welcome to the claimants and families page of the Birth-Injury Program page.
Program Forms
- Claimant Information Form (PDF download)
- Claimant Information Form (PDF Online Form) – Coming Soon!
- Family Contact Listing Form (for new claimant families)
- Monthly Care Summary
- 2025 Claimant Reimbursement Form – Coming Soon!
- 2024 Claimant Reimbursement Form (PDF download)
- 2024 Claimant Reimbursement Form (PDF Online Form)
- 2022 Claim Reimbursement Form (Excel file)
Program Handbook & Documentation
- Program Handbook
- Program Regulations (Virginia Administrative Code)
- Administrative Guidance On Processing Claims
- Previous Guidelines (Superseded by Regulations above)
- Medical Assistance Dog Administrative Guidance
Family caregivers and (non-family)
Independent Caregivers
- Start here –> Caregiver Setup Instructions – Updated Version Soon!
- Direct Deposit Form (PDF) – Updated Version Soon!
- Direct Deposit Form (PDF online form) – Updated Version Soon!
- Frequently Asked Questions and Answers
- Caregiver Timesheet (Family or Independent Caregiver)
- Caregiver Timesheet – for Family or Independent Caregiver
Caregiver Forms
- Monthly Care Form
- Competency Certification
- Liability Form – Caregiver
- Liability Form – Parent of Claimant
- Background Certification for Parent/Guardian Caregiver
- Background Certification for Single Parent/Guardian Caregiver
- Background Certification for Independent Caregiver
