Da 4700-2025

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The document outlines the eligibility criteria for respite care provided by the Army's Family and Morale, Welfare and Recreation Command for exceptional family members (EFMs). It specifies eight conditions under which a medical provider can determine eligibility, including severe disabilities and chronic health issues. The form must be completed by a medical provider and submitted to the installation's Exceptional Family Member Program Manager.

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Click ‘Get Form’ to open the da 4700 in the editor.
Begin by filling out the 'Patient's Identification' section. Enter the patient's first name, middle initial, last name, grade, date, and the hospital or medical facility.
In the 'Report Title' section, ensure you indicate 'Respite Care Eligibility Review' along with the OTSG approved date in YYYYMMDD format.
Review the eligibility criteria listed. Check all applicable boxes that indicate whether the exceptional family member meets any of the specified conditions.
Indicate if the limitation is permanent or temporary (valid for 2 years) based on your assessment.
Complete the 'Prepared By' section with your signature and title after reviewing all entries for accuracy.
Finally, provide a copy of this completed form to the family for submission to their installation Exceptional Family Member Program Manager.

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Versions	Form popularity	Fillable & printable
2003	4.9 Satisfied (374 Votes)
1978	4.3 Satisfied (43 Votes)

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