DD Form 2792 - Family Member Medical Summary

Scope

DD Form 2792, Family Member Medical Summary, February 2025 edition, electronic fillable, prescribed by DoDI 1315.19 under OMB 0704-0411. The form identifies a family member with special medical needs for Exceptional Family Member Program enrollment and family member travel screening. Two roles complete it in sequence: the sponsor, parent or guardian, or patient handles demographics and certification, and a qualified medical provider completes the medical summary. The certification on page 3 is signed only after the medical provider finishes the entire form.

Audience

Marines with a family member holding a qualifying condition complete the sponsor sections for mandatory EFMP enrollment, updates, and government sponsored travel requests. A qualified medical provider completes the medical summary. The installation EFMP coordinator and the S-1 track enrollment status, since a stale form leads to incorrect assignment coordination.

Purpose printed on the form

Evaluates and documents the special medical needs of family members. Privacy Act authorities are 10 U.S.C. 136, 20 U.S.C. 927, DoDI 1315.19, and DoDI 1342.12. The disclosure authorization releases patient information to the EFMP medical office, the Family Member Travel Screening office, and the EFMP Family Support Office. Service members with a family member holding a qualifying condition are required to enroll in the EFMP.

Demographics and certification section

• Item 1 states the purpose: EFMP enrollment or update, request for government sponsored travel, or a change in EFMP status covering a resolved condition, a deceased family member, loss of dependent status, or divorce and custody changes, each with verifying documentation.
• Item 7 selects the required action, starting with a first review of the family member medical history.
• Item 8 flags special assignment considerations. Marking possible special education or early intervention at 8a requires a companion DD Form 2792-1.
• Items 9 and 10 carry the family certification and the administrative certification.

Medical summary by a qualified provider

• Part A records patient status with current ICD diagnosis codes, diagnosis information, and provider information, plus expanded history sections for asthma, behavioral health within the last 5 years, and autism spectrum disorder or significant developmental delays with current intervention therapies and communication status.
• Part B records required medical specialties at item 14 with frequency of care codes from a specialty list running from allergist and applied behavior analyst through vascular surgeon.
• Items 16 through 19 cover artificial openings and prosthetics, medically indicated environmental and architectural considerations such as single story housing and air filtering, medically necessary adaptive equipment from apnea monitors to pacemakers with make and model, and limitations on daily living activities and travel.

Connection to Marine Corps policy

• DoDI 1315.19 prescribes the form and sets the DoD Exceptional Family Member Program framework, including mandatory enrollment.
• DoDI 1342.12 is a Privacy Act authority printed on the form.
• MCO 1754.5 implements EFMP at the Marine Corps level. Portal EFMP guidance cites both instructions together.
• DD Form 2792-1, Special Education and Early Intervention Summary, is the companion form. Marking possible special education or early intervention at item 8a requires it.
• The portal covers the enrollment workflow on the Exceptional Family Member Program page and the education handoff on the School Liaison Program page, with TRICARE coordination through the Extended Care Health Option.

Access

The external link opens the fillable PDF on the DoD Executive Services Directorate forms site.