PRINCIPAL Used to report items of information to individuals reporting for active duty. ... Information is used to report periods of active duty and physical condition upon entry and release from active duty.

Where can I find DD Forms?

To view DOD Forms, Directives, and Instructions, visit the following link: https://www.esd.whs.mil/DD/. From this main page, click on the DOD Forms or DOD Issuances drop-down menus in the toolbar to search for a specific form, directive or instruction by issuance number or subject matter.

How do I update Efmp?

Forms must be updated every three years or as your family status changes. To enroll or update in the EFMP, please do the following: Complete pages 1-3 of the Medical Summary DD Form 2792 (see forms below) and submit the entire document to a qualified medical professional who will complete pages 4-11.

Where can I get a DD Form 2058?

What is a DD Form 2058 and what is it used for? The DD Form 2058, State of Legal Residence Certificate, can be found in the Finance Office and is used by the Defense Finance and. Accounting Service (DFAS) to indicate that you have changed your domicile for military pay purposes.

What is a DD Form 2656?

IRS Withholding Certificate for Pension or Annuity Payments. DD 2656-10.

What is an Efmp screening?

The Exceptional Family Member Program (EFMP) is a Department of Defense program designed to identify and document the special medical and/or educational needs of a soldier's family members and ensure that those needs are considered during the assignment process.

Where can I get DD Forms?

To view DOD Forms, Directives, and Instructions, visit the following link: https://www.esd.whs.mil/DD/. From this main page, click on the DOD Forms or DOD Issuances drop-down menus in the toolbar to search for a specific form, directive or instruction by issuance number or subject matter.

Where can I find DD Forms?

To view DOD Forms, Directives, and Instructions, visit the following link: https://www.esd.whs.mil/DD/. From this main page, click on the DOD Forms or DOD Issuances drop-down menus in the toolbar to search for a specific form, directive or instruction by issuance number or subject matter.

What is a DD Form 2792?

DD Form 2792, "Family Member Medical Summary," August 2014 This form is used to document a family member's special medical needs and for enrollment in the Exceptional Family Member Program.

Get DD 2792 2021-2024

Q: What is a family member prefix for Military?

Family Member Prefix (FMP). Applies to Miliitary medical beneficiary only. The Family Member Prefix is assigned when the family member is enrolled in DEERS. ... The DBN can be found above the bar code on the back of the beneficiary&#039;s ID card.

Q: What is a DD Form 2792?

DD Form 2792, &quot;Family Member Medical Summary,&quot; August 2014 This form is used to document a family member&#039;s special medical needs and for enrollment in the Exceptional Family Member Program.

INSTRUCTIONS FOR COMPLETING DD FORM 2792 FAMILY MEMBER MEDICAL SUMMARY GENERAL. The DD Form 2792 and attached addenda are completed to identify a family member with special medical needs. DD FORM 2792 INSTRUCTIONS AUG 2014 Items 10. a. - c. To be completed by the administrator in consultation with the family. DD FORM 2792 ADDENDUM 1 AUG 2014 1. DIAGNOSIS ES. Please complete as accurately as possible using ICD-9-CM or when approved ICD-10-CM. Parent/ guardian or person of majority age certifies that the information contained in the DD 2792 is correct. SPECIAL ASSIGNMENT CONSIDERATIONS X all that apply a. Possible Special Education/Early Intervention If checked DD Form 2792-1 must be completed b. NAME OF PATIENT SIGNATURE OF PATIENT/PARENT/GUARDIAN RELATIONSHIP TO PATIENT DATE YYYYMMDD DD FORM 2792 AUG 2014 PREVIOUS EDITION IS OBSOLETE. Page 1 of 11 Pages Adobe Designer 9. Military only. Item 6. a. If Yes complete b. - c. Self-explanatory. Item 7. Identify current medically necessary adaptive equipment or special medical equipment used by the family member. Receiving TRICARE Extended Care Health Option ECHO Benefits c. Receiving State Medicaid/Medicare Waiver Services CERTIFICATION By signing below we certify that the information submitted on this DD Form 2792 is complete and accurate. There is a Certification Section on page 3 that should be signed AFTER the entire form is completed by medical provider s and the form has been reviewed for completeness and accuracy. The Parent/Guardian or Person of Majority Age signs block 11b and the MTF coordinator/authorized reviewer signs block 12b. A Qualified Medical Provider is responsible for assessing whether the services they are eligible to prescribe are within the scope of their practice and their state licensing requirements. AUTHORIZATION FOR DISCLOSURE Page 1 Health Insurance Portability and Accountability Act HIPAA Requirement. Please consult with your military treatment facility MTF or dental treatment facility DTF privacy/HIPAA coordinator about questions regarding authorizations for disclosure. DEMOGRAPHICS/CERTIFICATION Page 2. Item 1. Self-explanatory. Item 2. a* Family Member FM. Name of family member described in subsequent pages. Item 2. b. Sponsor Name. Name of the military member responsible for the family member identified in Item 2. a* Items 2. c* - e. Self-explanatory. beneficiary only. The Family Member Prefix is assigned when the family member is enrolled in DEERS* Item 2. g. DoD Benefits Number DBN. This 11-digit number has two components. The first nine digits are assigned to the sponsor the last two digits identify the specific person covered under that sponsor. The first nine digits do not reflect the sponsor s nine-digit SSN* The DBN can be found above the bar code on the back of the beneficiary s ID card. If the child has not been issued an ID card enter the first 9 digits of the parent s DBN* Items 2. h. - j. Self-explanatory. Items 3. a* - h. All items refer to the sponsor. Self-explanatory. Item 3. i.

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