Veterans Affairs

Department of

Memorandum

Date:

From: VA North Texas Health Care System, 4500 S. Lancaster Rd, Dallas, TX 75216

Subj: COURTESY FINGERPRINTING AT OTHER AFFILIATE

To: To Whom It May Concern:

Automated VA FORM 2105

2

To Whom It May Concern:

Dr. ______is currently a trainee at ______. He/She will be rotating at the VA North Texas Health Care System (VANTHCS) in Dallas, Texas in July 2017. The Associate Chief of Staff for Education Service at VANTHCS requests your help in assisting in the process of fingerprinting and security clearance from your facility for this trainee.

In processing the fingerprints, please use the following codes for the adjudication results to return to our facility.

SON#: 1367

SOI#: VAD5

OPAC-ALC: 3600-1200

If you have further questions or concerns, please contact Vicky Robertson () or Brandy Ruiz () at VANTHSC, Medical Service.

Thank you very much.

Richard Tyler Miller, M.D.

Chief, Medical Service

VA North Texas Health Care System

/vr

Automated VA FORM 2105