The Veterans Health Administration (VHA) is a leader in implementing healthcare-based intimate partner violence (IPV) screening and response. This study examined the early implementation of this program to assess clinical response to positive IPV screenings. We conducted an in-depth review of medical records for the six months following a positive IPV screen for all women patients who screened positive within the observation period in two medical centers (n = 208). Data included patient’s race, age, screening location, screening provider, screening response, and documentation of follow-up to positive screening, including interaction with an IPV Assistance Program Coordinator (IPVAP-C). The analysis, along with consultation with local staff for each site, revealed implementation challenges in consistency of response to IPV screens. Most (but not all) patients accepted offers of referral to the IPVAP-C. Case examples highlight the process of connecting with services and the content of support. Findings can be useful for VHA and other healthcare settings implementing IPV screening and response programs. Lessons learned include a need for processes for ensuring appropriate follow-up to a positive screen and that having an on-site IPVAP-C appears to be beneficial, although the uptake of such services is not universal.