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DA Form 7246 Exceptional Family Member Program (EFMP) Screening Questionnaire
What Is DA Form 7246?
DA Form 7246, Exceptional Family Member Program Screening Questionnaire , is a form filed by service members when enrolling a family member into the Exceptional Family Member Program (EFMP). This form serves as a summary of the health condition and needs of that family member and later plays a role when selecting assignments for the service member. The EFMP is a program that works throughout all branches of the Military together with civilian agencies to provide a comprehensive and coordinated approach to medical, educational, housing, and personnel services for families with special needs. The Army EFMP includes both personal support and family support functions.
The latest version of the form - often incorrectly referred to as DD Form 7246 - was released by the U.S. Department of the Army (DA) on June 1, 2009 . An up-to-date DA Form 7246 fillable version is available for digital filing and download below or can be found through the Army Publishing Directorate website.
How to File DA Form 7246?
An overview of the form and filing guidelines can be found in the Army Regulation 608-75, Exceptional Family Member Program. DA Form 7246 instructions are as follows:
- The first box at the top-right corner of the form requires the name of the medical treatment facility.
- The next section is for the service member's personal data. The required information requires their name, home address, home phone, rank, branch, unit, duty address, and duty phone along with the date of filing and the projected post, camp, or station of assignment.
- The service member has to list the family members that they would like to enroll in the EFMP. The lists require the names, sexes, and dates of birth of those family members. The service member has to specify if any of them is already enrolled in the EFMP.
- Block 1 is for providing information on any family members with additional medical records other than the ones already provided. If yes, it is necessary to specify the family member, their condition, and required services along with the name or address of the healthcare provider in the corresponding columns.
- Block 2 is for specifying if any of the listed family members have been hospitalized in the past five years. If yes, the name of that family member and the reason for hospitalization are provided in the corresponding columns of the table.
- The service member has to specify if any of the listed family members are currently receiving any medical or educational assistance from anyone other than a general practitioner or family practice physician.
- Block 4 is completed if any of the listed family members are currently taking prescription drugs other than birth control pills. If the answer is yes, the name of the family member and the prescribed drug must be specified in the corresponding boxes.
- Block 5 is completed if any of the listed family members have been treated for or had any problems connected with health issues from the list provided on the form in the last five years.
- Any prior treatment connected with mental health issues from the list provided on the form must be specified in Block 6.
- Block 7 is for specifying if any family members have ever stayed in inpatient psychiatric facilities, residential treatment centers, group homes, day treatment centers, or drug and alcohol treatmentrehabilitation centers.
- Block 8 is for providing information on any children of the service member that have any specific education-connected issues.
- Block 9 requires information on any dependent children receiving Special Education at school.
- The printed name of the service member - or "military sponsor" - or their spouse along with their signatures and the date of signing the form must be provided in the appropriate boxes on the second page of the DA 7246.
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Download DA Form 7246 Exceptional Family Member Program (EFMP) Screening Questionnaire
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