For Exceptional Family Member Program enrollment criteria see MCO 1754.4B , chapter 2, page 4. To enroll submit a DD Form 2792 Family Medical Summary. A DD Form 2792-1 is also required for children receiving special education services through an Individualized Family Service Plan (IFSP) or an Individualized Education Plan (IEP). For more information on EFMP enrollment please see: Important Information on Initial Enrollment, Re-Enrollment, and Disenrollment. To request direct support in completing your enrollment forms please contact the EFMP office at 703-693-4172/6510.
The DD Form 2792 Family Medical Summary (2014 Version) must be completed by ALL enrollees if the EFM is a child who is being enrolled for educational reasons. The form must be signed on pages 1 & 3 by a parent/guardian or by the EFM of majority age. Please make sure that the demographic information on page 2 (blocks 1 through 7) are completed, and sign and date the form on page 3 (block 11, a-c). The Medical Summary portion (pages 4-7) must be fully completed and signed by the attending medical provider. Medical providers must be a state licensed physician or certified/credentialed allied health care provider who is accepted by the Chief, BUMED. Complete Addendums if applicable.
Asthma/Reactive Airway Disease Summary
This section is to be completed and signed by a medical provider if the family member has a history of asthma or reactive airway disease.
Mental Health Summary
This section is to be completed by the mental health provider if the family member has a history associated with mental health.
Autism Spectrum Disorders and Significant Developmental Delays
This section is to be completed and signed by a medical provider if the family member has a history of autism spectrum disorder and/or significant developmental delay.
Download DD Form 2792 Sample Instructions (913 KB PDF)
The DD 2792-1 Special Education/Early Intervention Summary Enrollment Form (2014 Version) is required for:
- All infants and toddlers (birth to age 3) receiving Early Intervention Services via an Individualized Family Service Plan (IFSP) under the Individuals with Disabilities Education Act (IDEA).
- All school-age children (ages 3 through 21 inclusive) who are receiving special education services via an Individualized Education Program (IEP) under IDEA.
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 8 on page 3.
Updates and Disenrollment
The sponsor is responsible for updating EFMP paperwork every three years or sooner if there are changes in the family member’s condition or DEERS status. It is necessary to complete and submit all enrollment paperwork for update or disenrollment purposes. For more information on EFMP enrollment, update, and disenrollment please see: Important Information on Initial Enrollment, Re-Enrollment, and Disenrollment. To request direct support in completing your enrollment forms for update or disenrollment purposes please contact the EFMP office at 703-693-4172/6510.