/ VAWNY Healthcare System VAMC Donations
Thank you for your interest in making a donation to hospitalized veterans served by the VA WNY Healthcare System
1)Please complete all sections of this form; and
2)Send to Voluntary Service, VAWNY Healthcare System,3495 Bailey Ave. Buffalo, NY 14215.
3)To learn more about how you can enhance the services provided to VA WNY Healthcare System’s hospitalized veterans, please contact the Volunteer Manager at 716-862-8667.
Gift Amount: $______
Please direct my donation to the following account: (Check the appropriate box.)
General Post Funds for Earmarked Donations
1700 - CUSTOMER SERVICE
1800 – GUEST SHUTTLE VAN
1801 - SOCIAL WORK SERVICE
1802 - DAY TREATMENT CENTER
1804 - RECREATION FUND
1807 - HOMELESS VETERANS PROGRAM
1809 - ONCOLOGY FUND
1812 - PROSTHETICS TREATMENT CENTER
1813 - ADULT DAY HEALTH CARE
1815 – NATIONAL VETERANS GOLDEN AGE GAMES 2013
1816 -REHAB MEDICINE
1817 - COFFEE CART FUND
1820 - DISCRETIONARY, CHIEF ACCOUNT,
1821 - PATIENT COMFORT ITEMS
1826 - HEMODIALYSIS FUND
1827 - HOLIDAY FUND
1830 - VAVS SUPPORT FUND – BUFFALO
1831 –BATAVIA GENERAL PURPOSE FUND
1834 - PROTESTANT CHAPLAIN FUND
1837 - CATHOLIC CHAPLAIN FUND
1838 –PATIENT WELFARE ACCOUNT
1840 – BATAVIA HOLIDAY ACCOUNT
1841 - TV FUND
1848 - NATIONAL GAMES ACCOUNT
1860 - NURSING HOME CARE UNIT - WILLOW LODGE
1930 – BATAVIA RECREATION ACCOUNT
1931 - WOMENS WELLNESS CLINIC
1932 - DOMESTIC VIOLENCE PROGRAM
1933 - WOMEN VETERANS RESIDENTIAL PROGRAM
1935 – MEN’S PTSD RESIDENTIAL TREATMENT PROGRAM
1937 – NO ONE DIES ALONE
1939 - R.E.S.T.
1940 - VOCATIONAL PROGRAM
1941 - SUBSTANCE ABUSE
1942 - VISUALLY IMPAIRED FUND
1943 - NIAGARA FALLS CBOC
1944 - COMPING/SERVICE RECOVERY PROGRAM
1945 - VASCULAR / My Gift is in Memory of: ______
(See an explanation for each account
on the other side of this form)
Donor Information: (Provide All Information As It Appears On Your Credit Card)
First Name: ______Last Name: ______
Address: ______
City, State, Zip Code: ______
I wish this gift to be anonymous. / Telephone Number: ______-______-______
Best Time to Call: ______A.M./P.M.
E-mail: ______
SIGNATURE: ______
Credit Card Information: (Provide All Information As It Appears On Your Credit Card)
VISA
Mastercard
Discover
American Express / Card Number: ______
Expiration Month/Year: /
CVV:
(CVV is the 3-digit number on the back of your credit card.)
In accordance with VHA Directive 4721, we are required to state “The Department of Veterans Affairs did not provide you
the donor, any goods or services in consideration in whole or part for your contribution.”
1800 – GUEST SHUTTLE VAN / This account was established to initiate funding for a replacement van or upkeep as necessary. The Guest Shuttle Van is utilized each business day to transport patients, staff, volunteers etc to and from the outpatient entrance from their cars/drop-off points.
1801 - SOCIAL WORK SERVICE / Has been established to purchase tokens/transportation and haircuts for indigent patients.
1802 - DAY TREATMENT CENTER / is used to purchase items for use by veterans at the Day Treatment Center. These items may include but is not limited to tokens, food/beverages, tickets to activities within the community and transportation to these activities.
1804 - RECREATION FUND / is used to support various patient recreational and diversional activities that are hosted by the Recreational Therapy Department. These activities may include but is not limited to the purchase of food & refreshments (with donor permission), the funding of trips within the community, as well as the purchase of equipment and products that enhances patient well being.
1807 - HOMELESS VETERANS PROGRAM / is to purchase items that are needed by veterans in the HCHV Program. Items may include, but is not limited to, the purchase of bus tokens, transportation cost, food/beverages and clothing. Other items may include the purchase of housing supplies such as appliances, beds etc. These funds will also be used to fund various social activities that the veterans may attend out in the community. Some of the cost associated with these activities may include the purchase of tickets, transportation cost and food and beverages. funds may be used to cover the cost of replacing lost identity papers such as birth certificates, drivers licenses, etc.
1809 - ONCOLOGY FUND / This fund is used to support the Oncology Department in providing items that assist in the care and well being of oncology patients. This may include but ids not limited to the purchase of food and refreshments (with donor permission), as well as the purchase of equipment and products that assist with annual stand downs.
1810 - UNITED AUTO WORKER / The purpose of this account is to fund various patient activities and social events. This may include but is not limited to the purchase of food and refreshments (with donor permission) as well as various prizes to enhance patient picnics, Monte Carlos and pizza parties.
1812 - PROSTHETICS TREATMENT CENTER / This account is used to support the Prosthetics Department in providing items that assist in the care and well being of patients. This may include the purchase of products and equipment such as blind & low vision aids, wheelchair gloves, ice grippers for canes, etc.
1815-NATIONAL VETERANS GOLDEN AGE GAMES 2013 / This account is used to provide support and assistance for patients attending the National Games Events. The event will be hosted in Buffalo, NY.
1813 - ADULT DAY HEALTH CARE / This account was established to purchase a variety of items to support the Adult Day Health Care Clinic. These items may include the purchase of food and refreshments (with donor permission) for ward parties, baking products in support of the daily baking initiative and may be used to fund various entertainment activities for the patient's. Other uses may include the purchase of training products and other minor equipment such as DVD players.
1816 -REHAB MEDICINE / The purpose of this fund is to equipment or products for Rehabilitation Medicine Services in an effort to enhance patient care. Rehabilitation Medicine Services includes Physical Therapy, Occupational Medicine and Vocational Rehabilitation Therapy.
1817 - COFFEE CART FUND / This fund is used to purchase coffee, creamer, sugar and other coffee supplies and equipment that is used to service patients waiting for appointments.
1818 - LIBRARY FUND / This account is used to purchase periodicals, books, or other equipment that is needed in the Library for veteran use.
1820 - DISCRETIONARY, CHIEF ACCOUNT / This account was established to fund various veteran activities that enhance and support the facilities mission. This may include but is not limited to the purchase of items such as food/refreshments (with donor permission), equipment, training and education materials and other items that will support the Voluntary Service Program.
1821 - PATIENT COMFORT ITEMS / This account is used to purchase various patient comfort and hygiene times that may include trial size deodorant, toothpaste, toothbrush, shaving cream, combs, underwear and socks for indigent in-patients.
1825 - CHRISTMAS MORNING / This account is used to purchase items that are added to the individual Christmas Gift Bags that are then distributed to every hospitalized veteran on Christmas morning.
1826 - HEMODIALYSIS FUND / This fund is primarily used to purchase various items that are needed for the veterans who participate in our Hemodialysis Program. Items may include portable CD players, radios, televisions, batteries, and handheld games.
1827 - HOLIDAY FUND / This fund is used VAVS Holiday Account, was established to purchase various Holiday items that are needed for decorating. It is also for purchasing items that will be distributed to the veterans in their Holiday Gift Bags. Examples may include socks, knit caps, comfort items, wallets, nail clippers, candy canes, pens, gloves, canteen books and puzzle books. These funds may also be used to purchase food and refreshments (with donor permission) for holiday activities and parties.
1830 - VAVS SUPPORT FUND - BUFFALO / Used to purchase items that are needed to support various volunteer functions throughout the year. Examples include: Volunteer Gifts for National Volunteer Week, Christmas Cookies for Volunteers in December, Prizes for Volunteer Awards Ceremony in May, Volunteer Meals at the Volunteer Awards Ceremony.
1832 - NURSING DEVELOPMENT / Used for Nursing Development and Education. Expenditures are used to support the Nursing Education Programs and travel.
1834 - PROTESTANT CHAPLAIN FUND / This account was established to purchase prayer booklets, religious items, as well as refreshments for Chaplain observances/events. These may include Memorial Day, Four Chaplains, Holocaust, etc.
1836 - CHAPLAIN ACCOUNT / This account was established to purchase religious items for patient use such as prayer booklets and other religious items for the Batavia Facility.
1837 - CATHOLIC CHAPLAIN FUND / Is used to purchase religious items for patient use in the Catholic Chaplains program. These could include prayer booklets and other religious items.
1841 - TV FUND / This account is used to provide assistance in obtaining television sets for all patient areas throughout VA WNY Healthcare System.
1848 - NATIONAL GAMES ACCOUNT / This account is used to provide support and assistance for patients attending the National Games Events. These events may include the Golden Age Games, National Veterans Wheelchair Games, Winter Sports Clinic, Summer Sports Clinics and Creative Arts Festival.
1849 - GROUP MEDICAL PROJECT / This account is used to purchase items that are needed to support the educational programs and medical activities affiliated with osteoarthritis of the knee.
1856 - MEDICAL RESOURCE GENERAL 1 / This fund is used to support the administrative function of the medical research service. The purchase of common core equipment, service contracts, supplies and general support of consumables.
1860 - NURSING HOME CARE UNIT - WILLOW LODGE / This account was established to purchase various items that will benefit the patients in our Nursing Home Care Unit. The funds will be used to support a variety of functions such as the purchase of food and refreshments (with donor permission) for ward parties and baking products in support of the daily baking initiative. It may also be used to fund various entertainment activities for the patient's.
1880 - CENTRAL OFFICE ADVANCE FUND / This account was established to secure Central Office annual funding for various veterans gifts, needs and ceremonies throughout the year. The funds are used to promote Volunteer Recognition as deemed necessary
1931 - WOMENS WELLNESS CLINIC / Is used to purchase items that are needed for our female veterans in our Women's Wellness Center (i.e. educational brochures, training seminars, and various Outreach Programs. This account will also be used for expenditures from the "Susan B. Komen Grant Program".
1932 - DOMESTIC VIOLENCE PROGRAM / This account was established to assist female veterans within the Domestic Violence Program. This may include providing indigent female veterans with grocery gift certificates from local grocery stores. Also may be used to provide gift baskets during the holidays for female veterans and their family members.
1933 - WOMEN VETERANS RESIDENTIAL PROGRAM / This account was established to provide support of the women's residential program. This may include recreational events and activities, food and refreshments (with donor permission) and off-station excursions.
1935 - PRRP -MEN / This fund was established to support activities and off station trips for the Post Traumatic Stress Disorder Residential Treatment Program. This may also include the purchase of food and refreshments (with donor permission) to support the activities within the program.
1937 - NODA / 1. The General Post Fund 1937 Account was established to support the No One Dies Alone Program at VA WNY Healthcare System. The funds may be used for the physical comfort of veterans, this includes but is not limited to, special bed linens or pillows, small fans, personal care items like lotions, razors and nail clippers not normally in hospital stock. It may also be used for the stimulations of the senses. This may include purchasing lotions, aroma therapy items, baked goods or ingredients to make baked goods, popsicles, ice cream novelties, culturally sensitive meals or food items, snacks of all sorts, music (recorded or live entertainment), audio books, reading material or also tickets to community events or activities. These funds may also be used to enhance the patients environment which may include the purchase of small appliances such as small refrigerators
1938 - CARDIOLOGY RESEARCH FUND / To deposit reimbursements received in the course of providing cardiology services for funded research. The fund is to be used to enhance research and education in the cardiology section so as to provide better care for the patients. To purchase books, journals, educational software; support continuing medical education activities (attendance at conferences); support research and educational conferences and seminars (including the provision of refreshments); and to purchase equipment and supplies to support and enhance research and education.
1939 - R.E.S.T. / To support activities and services related to Operation Enduring Freedom and Operation Iraqi Freedom. Examples may include the purchase of food, refreshments (with donor approval), entertainment to support the R.E.S.T. picnic as well as, other community outreach initiatives.
1940 - VOCATIONAL PROGRAM / Account was established to purchase bus passes, tokens, etc. for veterans within the Vocational Program
1941 - SUBSTANCE ABUSE / To purchase items that are needed for veteran patients, especially those that will help with incentive therapy as part of their treatment process. Items may include shirts, hats, Canteen books, in addition to small appliances such as microwaves, coffee pots to support the programs need. (All items such as appliances are considered equipment and should be ordered through the 2237 process).
1942 - VISUALLY IMPAIRED FUND / To purchase visual impairment items needed for Veteran patients.
1943 - NIAGARA FALLS CBOC / This account was established to purchase items that are used to enhance patient care for Veteran patients at the Niagara Falls outpatient clinic.
1944 - COMPING/SERVICE RECOVERY PROGRAM / To purchase comping coupons for those Veteran patients who are in need of service recovery.
/ .