The clinic or practice and provider who will complete the medical summary.
DD 2792: Family Member Medical Summary (EFMP)
The FEB 2025 EFMP medical summary: the release, the family's demographics and certification (blocks 1–10), and a prep sheet for the provider's medical summary.
Every block on the DD Form 2792
Laid out block for block like the official FAMILY MEMBER MEDICAL SUMMARY (FEB 2025 edition), with the instruction for each block. Name, rank, and unit prefill from your service profile.
Authorization for disclosure of medical information
- I authorize (MTF / DTF / Civilian Provider) (Name of Provider) to release my patient information to the EFMP medical / FMTS Office and EFMP Family Support Office
- Name of Patient
- Relationship to Patient (if applicable)
Filled in when a parent or legal guardian signs for the patient.
- Date (YYYYMMDD)
The authorization starts on the date you sign. It lasts until EFMP enrollment is no longer needed, the family member no longer qualifies as a dependent, or the sponsor leaves active service.
Demographics / certification: to be completed by the sponsor, parent or guardian, or patient
- 1Purpose of This Form (Select One)
For a status change, provide documentation to verify it.
- 2aFamily Member / Patient Name
- 2bSponsor Name (Last, First, Middle Initial)
- 2cSponsor DoD ID #
- 2dFamily Member Sex
- 2eFamily Member Date of Birth (YYYYMMDD)
- 2fFamily Member Prefix (FMP)
Assigned when the family member was enrolled in DEERS (e.g., 30 for spouse, 01+ for children).
- 2gDoD Benefits Number (DBN) (On Back of ID Card)
11 digits, above the bar code on the back of the family member's ID card. If the child has no ID card, use the first 9 digits of the parent's DBN.
- 2hCurrent Family Member Mailing Address (Street, Apartment Number, City, State, ZIP Code, APO / FPO)
- 2iHome Telephone Number (Include Country Code / Area Code)
- 2jFamily Home E-mail Address
- 3aSponsor Rank or Grade
- 3bDesignation / NEC / MOS / AFSC (Military Only)
- 3cInstallation of Sponsor's Current Assignment
- 3dBranch of Service
- 3eStatus
- 3fSponsor's Official E-mail Address
- 3gDuty Telephone Number
- 3hMobile Number
- 3iDoes Family Member Reside with Sponsor? (If "No," Explain.)
- 4aAre You Dual Military or Is Your Spouse Former Military? (Military Only)
If either applies, complete 4b–4e.
- 4bSpouse's Name (Last, First, Middle Initial)
- 4cBranch of Service
- 4dRank / Rate
- 4eSpouse DoD ID #
- 5aHas the Family Member Ever Been Enrolled in DEERS Under a Different Sponsor's Name or DoD ID #?
- 5bIf "Yes," Under What DoD ID #?
- 5cUnder What Sponsor's Name? (Last, First, Middle Initial)
- 5dBranch of Service
- 6aDoes This Family Member Receive Case Management Services?
If yes, complete 6b and 6c.
- 6bLocation of Case Manager
- 6c(1)Case Manager Contact Information: Name (Last, First, Middle Initial)
- 6c(2)E-mail Address (If Available)
- 6c(3)Telephone Number
For administrative use only
- 7Required Actions (Select One)
Completed by the EFMP administrator with the family. (*Maintain documentation to verify change in status; do not update medical information.)
- 8Special Assignment Considerations (Mark all that apply)
If 8a is marked, a DD Form 2792-1 must also be completed.
Certification
- 9aParent / Guardian or Person of Majority Age: Printed Name
Do not certify before the medical provider completes the entire form.
- 9bSignature
- 9cDate (YYYYMMDD)
- 10aAdministrative Certification: Printed Name
Blocks 10a–f: the MTF case coordinator or EFMP administrator.
- 10bSignature
- 10cDate
- 10dLocation of Military Treatment Facility or Certifying EFMP Office
- 10eTelephone Number (Include Country Code / Area Code)
- 10fOfficial Stamp
Medical summary: part a - patient status (Qualified Medical Provider)
- 1–5Diagnosis Information (Diagnoses 1–4)
Completed and signed by the qualified medical provider (Diagnosis 1–2 on the first summary page, 3–4 on the next, with provider information in blocks 3 and 6). Use it to prepare accurate notes for the appointment. Prognosis options: Excellent, Good, Fair, Poor, Guarded, Unstable. Treatment plan covers the last 12 months and the next three years.
- 7History Associated with Asthma (triggers; oral steroids in the past year; urgent ER/clinic visits; hospitalizations in the past 5 years; ICU admissions)
- 8a–hBehavioral Health History Within the Last 5 Years (suicidal behaviors, substance misuse, addictive behaviors, eating disorders, other compulsive behaviors, problems with legal authority, psychotic episodes, services for allegations of family maltreatment)
The provider answers Yes or No to each of 8a–8h and adds details for any Yes.
- 9Current Intervention Therapies for Autism Spectrum Disorder and / or Significant Developmental Delays
Rows printed on the form: (1) Speech Therapy, (2) Occupational Therapy, (3) Physical Therapy, (4) Psychological Counseling, (5) Intensive Behavioral Intervention (includes ABA), (6) Other (specify).
- 10Communication
If non-verbal, the provider indicates the communication methods used.
- 12Behavior: Child Exhibits High Risk or Dangerous Behavior
- 11Other Interventions / Therapies Used by the Family (Specify alternate or complementary therapies)
Medical summary: part b - required medical specialties (Qualified Medical Provider)
- 14Health Care Required: specialists REQUIRED to meet the patient's needs
Mark only specialists needed for ongoing care, not ones used only to make a diagnosis. If a developmental pediatrician is the primary care manager but a pediatrician meets the needs, mark developmental pediatrician. Educational services go on the DD 2792-1.
- 16Artificial Openings / Prosthetics
- 17Medically Indicated Environmental / Architectural Considerations
The provider specifies and justifies each consideration.
- 18Medically Necessary Adaptive Equipment / Special Medical Equipment
- 19Limitations for Activities of Daily Living and Any Travel Limitations (Please explain.)
- 3, 6, 13, 15, 20Provider Information (Printed Name or Stamp, Signature, Date, Telephone, Official Email, Medical Specialty)
Each provider signs the pages they complete: blocks 3a–f and 6a–f (diagnoses), 13a–c (additional information), 15a–c and 20a–c (Part B).
Draft / worksheet aid. Prepare it here, then transcribe into Your installation EFMP medical office (or Family Member Travel Screening office); enrollment records in the Service's EFMP system (e.g., EFMP & Me / Enterprise EFMP). This is not an official submission. Check it against the current official DD Form 2792 before use.
How to fill out the DD Form 2792
The form that documents a family member's special medical needs for EFMP enrollment, updates, and overseas travel screening, so assignments match your family to places with the care they need. When: When a family member has a qualifying medical condition (enrollment is mandatory for military sponsors), at least every 3 years or when the condition changes, and before accompanied overseas or remote orders.
Step by step
- Page 2: the patient (or parent/guardian for a minor) signs the authorization naming the provider who will release information. Each adult family member signs for their own records.
- Page 3, blocks 1–6: the sponsor fills in the purpose, family member, sponsor, dual-military, prior DEERS sponsor, and case-management details.
- Give the form to each qualified medical provider to complete the Medical Summary (Parts A and B) and sign their pages.
- Only after the providers finish: the parent/guardian or adult family member certifies block 9. The EFMP office completes blocks 7, 8, and 10.
- If block 8a is marked (possible special education/early intervention), also complete the DD 2792-1.
What a strong one looks like
- Bring the provider a one-page summary: diagnoses, medications and doses, specialists you see, therapies with hours per week, and equipment. The prep section below lays it out in the form's order.
- The DoD Benefits Number (block 2g) is on the back of the family member's ID card, above the bar code.
- Enrollment doesn't hurt your career. It's there so the Army, Navy, Marine Corps, or Air & Space Force doesn't send your family somewhere the care doesn't exist.
Common mistakes
- Signing block 9 before the providers complete the medical summary. The form says not to.
- Missing the page 2 authorization, or a sponsor signing for an adult family member who isn't under court-appointed guardianship.
- Letting the enrollment go stale. Out-of-date summaries hold up assignment and travel screening.
Related Personnel & Career worksheets
Fill, save & export this worksheetPrefilled from your profile · autosaves to your account · export to PDF. Free to preview, Pro to save & export.
Open it in the toolkit