important highlights for the completion of dd form 2792 family member medical summary mccs camp...
TRANSCRIPT
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Important Highlights for the Completion of DD Form 2792
“Family Member Medical Summary”
MCCS Camp Allen EFMP Office
• DD Form 2792 must be completed for all EFMP enrollees.• DD Form 2792 (and DD Form 2792-1, if applicable) are also the forms used when
updating EFMP paperwork every three years, when the condition changes, or the EFM needs to be otherwise disenrolled (per MCO 1754.4B).
• Please be sure to use the most current version of the form, which has “DD Form 2792, APR 2011” on the bottom of the pages.
• If the EFM is a child, regardless of age, a DD Form 2792-1 must also be completed and submitted with the DD Form 2792. (Please see the other set of instructions for the completion of DD Form 2792-1.)
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To authorize the release of the patient’s medical information, please enter the name of the Military Treatment Facility or Provider here.
If the EFM/patient is at Age of Majority, he/she must sign the medical summary. EFMP paperwork can be signed by sponsor’s spouse if the patient is a child under the Age of Majority.
DD Form 2792Page 1
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Please check the appropriate box here depending upon the purpose of the completion of this particular DD Form 2792 (enrollment vs. update, etc.).
If the EFM/patient is at Age of Majority, he/she must sign the medical summary. EFMP paperwork can be signed by sponsor’s spouse if the patient is a child under the Age of Majority.
DD Form 2792Page 2
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Please have a qualified medical provider fill out the Medical Summary section beginning here.
NOTE: It is important that the provider also fills out the Asthma, Mental Health and Autism/Developmental Delay Addenda, even if no history of one or more of them exists.
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Please have the medical provider sign and date here.
DD Form 2792Page 7
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Please have the medical provider sign and date here, regardless of whether he/she checked “NO” or “YES” above.
DD Form 2792Page 8
Please be sure the medical provider checks “NO” or “YES” here. If “YES,” the rest of the Asthma/Reactive Airway Disease Summary addendum must be completed.
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DD Form 2792Page 9
Please be sure the medical provider checks “NO” or “YES” here. If “YES,” the rest of the Mental Health Summary addendum must be completed.
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Please have the medical provider sign and date here, regardless of whether he/she checked “NO” or “YES” on Page 9.
DD Form 2792Page 10
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Please have the medical provider sign and date here, regardless of whether he/she checked “NO” or “YES” above.
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