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Get DA 5888 2002-2024

ADDRESS e. PHONE NUMBER Include Commercial and DSN 11. ARMY MTF EFMP PHYSICIAN S AUTHENTICATION To be signed when a medical practitioner other than a physician completes this form. a. TYPED OR PRINTED NAME OF PHYSICIAN c. RANK DA FORM 5888 SEP 2002 EDITION OF AUG 1995 IS OBSOLETE USAPA V1. FAMILY MEMBER DEPLOYMENT SCREENING SHEET For use of this form see AR 608-75 the proponent agency is OACSIM AUTHORITY PRINCIPAL PURPOSE ROUTINE USES DISCLOSURE DATA REQUIRED BY THE PRIVACY ACT OF 1974 Title 10 USC Section 3013. Personnel support. To validate family member deployment screening and to provide gaining command with data to assist in making an assignment decision* The provision of requested information is mandatory. Failure to respond may preclude successful processing of an application for family member travel/command sponsorship and may lead to appropriate administrative or disciplinary action against the soldier. 1. NAME OF SOLDIER Last first MI PART A - SOLDIER/FAMILY MEMBER DATA 2. SOCIAL SECURITY NUMBER 4a* HOME ADDRESS 5a* DUTY ADDRESS 4b. HOME PHONE NO. Include Area Code 3a* RANK 3b. MOS/BRANCH 5b. DUTY PHONE NO. a* DSN b. COMMERCIAL Include area code a* NAME 6. DATE OF EDAS CYCLE OR RFO 0FF DATE 7. FAMILY MEMBERS b. RELATIONSHIP c* DOB YYYYMMDD a* MILITARY PERSONNEL DIVISION/PERSONNEL SERVICE COMPANY REPRESENTATIVE S NAME 8. AUTHENTICATION c* RANK Grade b. TITLE d. SIGNATURE e. DATE YYYYMMDD PART B - FAMILY MEMBER SCREENING RESULTS EXCEPTIONAL FAMILY MEMBER PROGRAM EFMP ENROLLMENT Check one 9. NAME a* NOT WARRANTED b. CONSIDERATION sent for Coding c* SUBSTANTIAL CHANGE SINCE ENROLLMENT NO YES DATE SENT FOR CODING 10. ARMY MEDICAL TREATMENT FACILITY MTF EFMP MEDICAL PRACTITIONER COMPLETING THIS FORM a* PRINTED NAME OF MEDICAL PRACTITIONER d. FAMILY MEMBER DEPLOYMENT SCREENING SHEET For use of this form see AR 608-75 the proponent agency is OACSIM AUTHORITY PRINCIPAL PURPOSE ROUTINE USES DISCLOSURE DATA REQUIRED BY THE PRIVACY ACT OF 1974 Title 10 USC Section 3013. Personnel support. To validate family member deployment screening and to provide gaining command with data to assist in making an assignment decision* The provision of requested information is mandatory. Personnel support. To validate family member deployment screening and to provide gaining command with data to assist in making an assignment decision* The provision of requested information is mandatory. Failure to respond may preclude successful processing of an application for family member travel/command sponsorship and may lead to appropriate administrative or disciplinary action against the soldier. Failure to respond may preclude successful processing of an application for family member travel/command sponsorship and may lead to appropriate administrative or disciplinary action against the soldier. 1. NAME OF SOLDIER Last first MI PART A - SOLDIER/FAMILY MEMBER DATA 2. SOCIAL SECURITY NUMBER 4a* HOME ADDRESS 5a* DUTY ADDRESS 4b. 1. NAME OF SOLDIER Last first MI PART A - SOLDIER/FAMILY MEMBER DATA 2. SOCIAL SECURITY NUMBER 4a* HOME ADDRESS 5a* DUTY ADDRESS 4b. HOME PHONE NO. Include Area Code 3a* RANK 3b. MOS/BRANCH 5b. DUTY PHONE NO. a* DSN b. COMMERCIAL Include area code a* NAME 6. .

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