The 4700 form is an important document for small businesses and independent contractors. It is a document that can be used to reduce taxes and protect your business interests. This form can be used to report income and expenses, as well as claim certain deductions. Understanding how to use the 4700 form can help you save money on your taxes and keep your business running smoothly.
| Question | Answer |
|---|---|
| Form Name | Da 4700 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | da form 4700 pdf, dd 4700, da form 4700, dd form 4700 |
MEDICAL
For use of this form, see AR
REPORT TITLE
Respite Care Eligibility Review
OTSG APPROVED (Date)
(YYYYMMDD)
The Army, through its Family and Morale, Welfare and Recreation Command (FMWRC), is offering respite care to exceptional family members (EFMs) who meet one or more of the eligibility criteria listed below. A medical provider must indicate whether the EFM meets one or more of the following criteria.
1. Little or no age appropriate
2. Severe continuous seizures activity.
3. Ambulation with neurological impairment that requires assistance with activities of daily living.
4. Tube feeding.
5. Tracheotomy with frequent suctioning.
6. Apnea monitoring during hours of sleep, if another family member must remain awake during monitoring.
7. Inability to control behavior with safety issues requiring constant supervision.
8. Life threatening or chronic condition requiring frequent hospitalizations or treatment encounters, which require extensive family involvement in care giving.
The limitation is permanent. or
The limitation may not be permanent, and the checked criteria are valid for 2 years at your current installation.
The Individual does NOT meet any of the above eight eligibility criteria.
Provide a copy of this form to the family for submission to the installation Exceptional Family Member Program Manager.
"Exception revision approved by APD, 23 Feb 2009"
|
|
(Continue on reverse) |
|
|
|
|
|
PREPARED BY (Signature & Title) |
DEPARTMENT/SERVICE/CLINIC |
|
DATE (YYYYMMDD) |
|
|
|
|
PATIENT'S IDENTIFICATION (For typed or written entries give: Name |
|
last, |
|
|
|
|
|
||
first, middle; grade; date; hospital or medical facility) |
HISTORY/PHYSICAL |
FLOW CHART |
||
|
|
|
||
|
|
|
OTHER EXAMINATION |
OTHER (Specify) |
|
|
|
OR EVALUATION |
|
|
|
|
DIAGNOSTIC STUDIES |
|
|
|
|
TREATMENT |
|
DA FORM 4700, FEB 2003 EDITION OF MAY 78 IS OBSOLETE. MEDCOM OP 40
MC PE v2.00
APD PE v1.01ES