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Da 4700-2026
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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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