Instructions
Use the form to request additional medications or supplies, mail it at least 14 days before the supply is exhausted, and check the patient identification blanks before mailing.
10-2478
Veterans Request for Refill of Medications and/or Medical Supplies
- Agency
- VA
- Revision
- July 2006
- Fillable fields
- 28
- Pages
- 1
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-2478: Veterans Request for Refill of Medications and/or Medical Supplies
VA Form 10-2478 is the U.S. Department of Veterans Affairs Veterans Request for Refill of Medications and/or Medical Supplies. VA's form page lists it under VHA. The instructions say the form is for requesting additional medications or supplies, and to mail it in at least 14 days before the supply is exhausted.
The form says prescriptions more than six months old cannot be refilled, and to list only current prescriptions. It asks for each prescription number and the name of the medication or medical supply, then the patient's identification: name, Social Security number, date, address, telephone and signature. The form says to check that all patient identification blanks are completed before mailing.
VA's form page also links to an online tool at va.gov/health-care/refill-track-prescriptions/. You can fill out the PDF free in your browser on this page and download the result without an account.
What's on VA Form 10-2478
Prescription list
Columns for the prescription number and the name of each medication or medical supply, with a reminder to list only current prescriptions.
Caution
A reminder to carefully check all medications after receiving them and to phone the pharmacy if any appear different.
Patient's identification
Print or type the name, Social Security number, date, number and street, city, state and ZIP code, telephone with area code, and the patient's signature.
Privacy notice
The information is solicited under Title 38, U.S. Code, and used to process the prescription. The form says disclosure is voluntary, but processing may be delayed if the information is not furnished.
How to fill out VA Form 10-2478
- 1
List your prescriptions
Enter the prescription number and the name of each current medication or medical supply.
- 2
Fill in your identification
Print or type your name, Social Security number, date, address and telephone number. The form says the name and address help insure prompt delivery of medication.
- 3
Sign it
Sign in the patient's signature box.
- 4
Check it over
The form asks you to check that all patient identification blanks have been completed before mailing.
- 5
Mail it early
The instructions say to mail it in at least 14 days before your supply is exhausted.
Why fill Form 10-2478 on indox
You get the real form, filled in a browser tab, with nothing standing between you and the finished PDF.
- Fill the form right in your browser, no software to install
- Free to fill and free to download, with no account
- The official blank straight from the VA, not a copy someone retyped
- Works on a phone, tablet or computer
Where to send it and other details
Where to send it
The form says to mail it in but does not print a mailing address, and VA's page does not list one.
Online
VA's form page links to an online tool at va.gov/health-care/refill-track-prescriptions/.
Timing
Mail it at least 14 days before your supply is exhausted. Prescriptions more than six months old cannot be refilled.
Edition
The PDF is dated JUL 2006 (R) and says existing stock of VA Form 10-2478, MAY 1991, will be used.
Related forms
Who uses VA Form 10-2478?
The form is written for the patient asking for the refill.
Official sources and the blank
Do it all with indox
No tool matches that search.
Questions about Form 10-2478
What is VA Form 10-2478 for?
The instructions say it is for requesting additional medications or supplies by mail.
How early should it be mailed?
The instructions say to mail it in at least 14 days before your supply is exhausted.
Can old prescriptions be refilled with this form?
The form says prescriptions more than six months old cannot be refilled, and to list only current prescriptions.
Is there an online option?
VA's form page links to an online tool at va.gov/health-care/refill-track-prescriptions/.
Is giving the information voluntary?
The privacy notice says disclosure is voluntary, but processing of the prescription may be delayed if the information is not furnished. It says this has no adverse effect on any other benefit.
What if a medication looks different?
The form says to carefully check all medications after receiving them and to phone the pharmacy immediately for clarification if any appears different from what you have been taking.