DA Form 7419-2 Exceptional Family Member Program (EFMP)

DA Form 7419-2 - also known as the "Exceptional Family Member Program (efmp)" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 7419-2 - was last revised on August 1, 2007. Download an up-to-date fillable PDF version of the DA 7419-2 down below or look it up on the Army Publishing Directorate website.

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(NOTE: Pre-site
EXCEPTIONAL FAMILY MEMBER PROGRAM (EFMP)
materials are annotated
For use of this form, see AR 608-1; the proponent agency is ACSIM.
with an asterisk *)
10000 ARMY COMMUNITY SERVICE
10000.1 The garrison commander has established the installation EFMP committee. CAT 1 (Rehabilitation Act and DODD 1020.1)
Review committee minutes to validate
Quarterly meetings.
Required membership.
Appointment orders.
Discussion and resolution of EFMP issues.
Garrison commander approval of minutes.
10000.2 The Special Needs Accommodation Process (SNAP) Team is a subcommittee of the installation EFMP committee. CAT 1
(Rehabilitation Act and DODD 1020.1)
*Ensure SNAP SOP:
Structures the team as a subcommittee of the installation EFMP committee.
Depicts team chairperson and membership stated in AR 608-75.
Outlines SNAP objectives, referral process, placement of children, training/follow-up technical assistance, administering medication,
performing care-giving health practices, and policy exceptions.
Addresses SNAP Review Team per AR 608-75.
Review SNAP minutes to validate:
Determination of child care and youth supervision placement considering feasibility of program accommodations and availability of
services to support child/youth needs.
Recommendation of placement setting that accommodates to the extent possible the child or youth's individual needs.
10000.3 An installation EFMP SOP is on file. CAT 1 (Rehabilitation Act and DODD 1020.1)
*Ensure installation EFMP SOP addresses how each of the EFMP component activities (ACS, medical, military personnel, civilian
personnel, directorate of public works, child and youth services and community recreation) implement regulatory responsibilities and
functions.
10000.4 An EFMP roster of enrolled Soldiers is established. CAT 1 (Rehabilitation Act and DODD 1020.1)
Ensure the roster-
Is alphabetized by name of Soldier.
Contains demographic information on DD Form 2792 and DD Form 2792-1.
Information is easily retrievable.
DA FORM 7419-2, AUG 2007
Replaces DA Form 7419-R, OCT 2004.
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(NOTE: Pre-site
EXCEPTIONAL FAMILY MEMBER PROGRAM (EFMP)
materials are annotated
For use of this form, see AR 608-1; the proponent agency is ACSIM.
with an asterisk *)
10000 ARMY COMMUNITY SERVICE
10000.1 The garrison commander has established the installation EFMP committee. CAT 1 (Rehabilitation Act and DODD 1020.1)
Review committee minutes to validate
Quarterly meetings.
Required membership.
Appointment orders.
Discussion and resolution of EFMP issues.
Garrison commander approval of minutes.
10000.2 The Special Needs Accommodation Process (SNAP) Team is a subcommittee of the installation EFMP committee. CAT 1
(Rehabilitation Act and DODD 1020.1)
*Ensure SNAP SOP:
Structures the team as a subcommittee of the installation EFMP committee.
Depicts team chairperson and membership stated in AR 608-75.
Outlines SNAP objectives, referral process, placement of children, training/follow-up technical assistance, administering medication,
performing care-giving health practices, and policy exceptions.
Addresses SNAP Review Team per AR 608-75.
Review SNAP minutes to validate:
Determination of child care and youth supervision placement considering feasibility of program accommodations and availability of
services to support child/youth needs.
Recommendation of placement setting that accommodates to the extent possible the child or youth's individual needs.
10000.3 An installation EFMP SOP is on file. CAT 1 (Rehabilitation Act and DODD 1020.1)
*Ensure installation EFMP SOP addresses how each of the EFMP component activities (ACS, medical, military personnel, civilian
personnel, directorate of public works, child and youth services and community recreation) implement regulatory responsibilities and
functions.
10000.4 An EFMP roster of enrolled Soldiers is established. CAT 1 (Rehabilitation Act and DODD 1020.1)
Ensure the roster-
Is alphabetized by name of Soldier.
Contains demographic information on DD Form 2792 and DD Form 2792-1.
Information is easily retrievable.
DA FORM 7419-2, AUG 2007
Replaces DA Form 7419-R, OCT 2004.
Page 1 of 9
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10000.5 All relocating Soldiers EFM housing and community support needs are assessed and shared with the gaining command prior to
departure from the installation. CAT 1 (DODD 1342.17 and DODI 1342.22)
Review completed DA Forms 7415.
Ensure client contact logs and case records document housing and community support assessment and notification.
10000.6 The losing ACS informs relocating families of exceptional school age children about the need to obtain the following
information for transitioning to the new school: a copy of the IEP, a summary of educational activities and performance for the current
or past school year and any medical records. CAT 1 (DODD 1342.17)
Ensure client contact logs and case records document provision of information to help children transitioning to a new school.
10000.7 The gaining ACS links parents with appropriate special education school officials and medical providers and, upon request of
parents, participates in the individualized education program process. CAT 1 (DODD 1342.17)
Ensure client contact logs and case records document compliance with standard.
10000.8 The installation EFMP manager assists EFMP families in developing solutions to EFMP issues and problems (for example,
inaccessible facilities and programs). CAT 1 (Rehabilitation Act and DODD 1020.1)
Ensure client contact logs and case records document assistance to families with EFMP issues and problems.
Conduct focus group of EFMP families to ensure EFM services are provided.
10000.9 ACS informs EFMP families about the availability of community support services and educational resources.
CAT 1 (DODD 1342.17)
Ensure ACS information and referral file contains accurate information on organizations and agencies serving individuals with disabilities and
chronic illnesses.
Ensure client contact logs and case records document provision of information, assessment and referral to military and civilian EFMP
community support services.
10000.10 ACS provides EFMs with information about rights and responsibilities under local, State and Federal laws following
coordination with the servicing staff or command judge advocate. CAT 2 (5 points)
Review information about EFM rights and responsibilities. (2 points)
Ensure client contact logs and case records document provision of information about rights and responsibilities in coordination with servicing
or command judge advocate. (3 points)
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DA FORM 7419-2, AUG 2007
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10000.11 ACS facilitates EFMP support groups. CAT 1 (DODD 1342.17)
Review listing of support groups and advocacy organizations in EFMP section of ACS information and referral file.
Ensure client contact logs and case records document provision of advocacy and support group information.
Review support group agendas and group session logs.
10000.12 ACS has an EFMP command information and education program. CAT 2 (5 points)
*Ensure EFMP command information and education plan (3 points)
Is prepared annually.
Outlines component agency responsibilities, tasks and milestones.
Is monitored quarterly for implementation.
Ensure articles are published quarterly and EFMP brochure is on file. (1 point)
Review schedule and group session logs for briefings, education and training sessions. (1 point)
10000.13 If not available or accessible through military CYS (for example, adult respite care and care user's home), TRICARE Extended
Care Health Option or civilian resources, ACS establishes and maintains a respite care program for eligible family members with
disabilities. CAT 1 (DODD 1342.17)
*Ensure appropriate SOP addresses ACS implementation of respite care program per AR 608-75.
*Ensure memorandum of understanding/memorandum of agreement with CYS and/or civilian community document provision of respite care
per AR 608-75.
Review respite care provider recruitment materials and respite care provider training schedule, outline and group session logs.
Ensure completed DA Form 3063 validates certified homes and placements.
10000.14 ACS coordinates with CYS, military community recreation and with applicable civilian agencies to ensure that recreational
and cultural programs are available and accessible to family members with disabilities. CAT 1 (Rehabilitation Act and DODD 1020.1)
*Ensure SOP addresses implementation of recreational and cultural programs for family members with disabilities (military and/or civilian
community).
*Ensure memorandum of understanding/memorandum of agreement document provision of recreational and cultural programs per AR 608-75.
Review schedule and outline of programs.
Interview CYS Coordinator and Community Recreation Division Chief.
Ensure client contact logs and case records document coordination and provision of recreational and cultural programs.
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DA FORM 7419-2, AUG 2007
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20000 ARMY MEDICAL DEPARTMENT
20000.1 The MTF commander has appointed qualified staff to perform the EFMP functions. CAT 1 (Federal Managers' Financial
Integrity Act of 1982)
*Review documentation of appointment for three positions:
EFMP physician.
EFMP case coordinator.
Special needs advisor.
20000.2 The SNA documents assignment coordination activities with Military Personnel Agency. CAT 2 (5 points)
Review suspense filed DA Forms 7413 or equivalent documentation:
90%of all queries are documented. (4 points) or
80% of all queries are documented. (3 points) or
70% of all queries are documented. (2 points)
*Ensure clinic SOP includes instructions to document coordination activities. (1 point)
20000.3 EFMP physician reports medical resourcing needs to the MTF commander or representative. CAT 2 (5 points)
Review documentation of current or past requests to obtain required personnel and/or material resources. (3 points)
*Ensure clinic SOP contains description of request process. (2 points)
20000.4 The EFMP case coordinator distributes published EFMP identification criteria in the MTF. CAT 2 (5 points)
Ensure evidence exist through documentation or demonstration that EFMP identification criteria are distributed and available throughout the
MTF. (4 points)
*Ensure clinic SOP contains instructions for distributing EFMP identification criteria. (1 point)
20000.5 EFMP physician ensures that all medical providers receive training to become knowledgeable of EFMP requirements.
CAT 2 (5 points)
Review documentation of a training process that reasonably ensures that all MTF medical providers receive training on EFMP identification
criteria and referral process. (3 points)
Review examples of instructional materials. (1 point)
*Ensure clinic SOP describes how training is executed. (1 point)
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DA FORM 7419-2, AUG 2007
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20000.6 MTF commander directs health care providers to screen family members for possible enrollment in EFMP during routine health
care services. CAT 2 (5 points)
*Review MTF commander's directive. (4 points)
*Ensure clinic SOP contains instructions for implementing directive. (1 point)
20000.7 The OCONUS family member deployment screening is completed per paragraph 2-1b and Appendix E, AR 608-75.
CAT 1 (DoDI 1315.19)
Review DA Form 5888s (Family Member Deployment Screening Sheet) to document correct completion of records.
EFMP physician or trained designee is authenticating signature.
Completed DA Form 5888 has MTF EFMP stamp.
If medical/developmental problems are identified, the physician or medical practitioner will indicate under Part B of DA Form 5888 that
enrollment is warranted; otherwise indicate not warranted.
If needed, DD Form 2792 and/or DD Form 2792-1 are attached.
Review completed DA Forms 7246.
*Ensure clinic SOP defines and states that all of the above procedures are completed in accordance with AR 608-75.
20000.8 The EFMP physician ensures that EFMP summaries are completed and distributed per paragraph 3-1, AR 608-75.
CAT 2 (5 points)
Ensure EFMP office procedure documents processing of individual records. The procedure addresses: (4 points)
Forwarding DD Form 2792 and/or DD Form 2792-1 to the RMC for coding.
Receiving computer hard copy print out of EFMP Summary from RMC.
Forwarding copy of computer hard copy printout of EFMP Summary to outpatient treatment records section.
*Ensure clinic SOP includes description of summary procedures. (1 point)
20000.9 The EFMP case coordinator forwards demographic information on DD Form 2792 and DD Form 2792-1 to installation EFMP
manager. CAT 2 (5 points)
Review documentation that information is forwarded to installation EFMP manager when a family member is enrolled. (3 points)
Interview installation EFMP manager to verbally confirm that process for forwarding information is current. (1 point)
*Ensure clinic SOP describes process for forwarding information to the installation EFMP manager. (1 point)
20000.10 The MTF commander provides statistical data to the installation EFMP manager for DA Form 3063. CAT 1 (DODI 1342.22)
Interview installation EFMP manager to verbally confirm receipt of data.
*Ensure clinic SOP contains instructions in the collection and distribution of required data.
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DA FORM 7419-2, AUG 2007
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Download DA Form 7419-2 Exceptional Family Member Program (EFMP)

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