| Exceptional Family Member Program - Forms and Instructions |
Authorization to Release DD Form 2792 and 2792-1 In order to provide services the sponsor and/or spouse must sign a release form for minors. Anyone over the age of 18 has to sign their own Release of Information. Release of information allows the local office to provide you with assistance, referrals, and respite care. Declination of Family Case Management A sponsor and/or family member may also decline family case management services provided by the installation EFMP office. If you elect to sign the Declination of Services, the local EFMP office will have no contact with you and your family. Contact will be HQMC only. |
| The information on these forms and addendas will be used to determine whether there are adequate medical, housing and community resources to meet your special medical needs at the sponsor’s proposed duty locations. Application/Form DD2792 (also used for biannual updates) |
Medical Summary: This form is completed by both the sponsor or parent and the qualified medical provider. Please make sure that the demographic information on page 2 (in blocks 1 through 10a) is completed and the names of the family member and sponsor’s SSN is at the top of the other pages. Make sure that you have read and signed page 1 (Authorization for Disclosure of Medical Information) which gives the appropriate Manpower and Family Service Center representatives the authority to disclose information for the assignment coordination process. Pages 3 through 7 are completed by the qualified medical provider. www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2792.pdf Application/Form DD2792-1(must be completed on all children, ages 5-21, enrolled in grades K-12) |
| Special Education/Early Intervention Summary: This form is completed by the parent and/or sponsor and the school representative. The parent and/or sponsor should complete the demographic information on page 2 and blocks 1 and 2 on page 3. The school representative completes the information in blocks 3 through 6 on page 3. If your child is receiving accommodations or services through the school system please bring in a copy of the Individualized Education Plan, 504 Plan, or Student Plan specifying the accommodations and/or services. www.dtic.mil/whs/directives/infomgt/forms/eforms/dd2792-1.pdf |
| Exceptional Family Member Program (EFMP)Case Manager Bldg. 645 Rm 301 MCAS Box 99132 Yuma AZ 85369-9132 Phone: 269-5233 |