Basic Requirements for a Family Care Plan
Family Care Plan Counseling Checklist ____________
DA Form 5304
Family Care Plan ____________
DA Form 5305
Letter of Instruction __2 Copies__
Certificate Of Acceptance as Guardian or Escort ____________
DA Form 5840 (Short Term)*
Power of Attorney ____________
DA Form 5841 (Short Term)*
Certificate of Acceptance as Guardian or Escort __2 Copies__
DA Form 5840 (Long Term)*
Power of Attorney __2 Copies__
DA Form 5841 (Long Term)*
Application for Uniformed Services 2 Copies__
Identification Card – DEERS Enrollment
Allotment or Financial Support – as stated in AR 600-20 ___________
Parental Consent (If appropriate) ___________
DA Form 7666
Family Care Plan Preliminary Screening (If appropriate) ___________
DA Form 7667
Family Care Plan:
(Attached forms: 5840-R, 5841-R, DD Form 1172, Form 5305-R, 2558, 5304-R and Special Care Instructions).
Letter of Instruction Family Care Plan:
I/We _______________ parent(s) of _________________________________________, do issue the following instructions for the care of my/our child(ren) during my (our) absence, or in the even that I/We are unable to meet his/her/their needs due to an absence as the result of military service with BRANCH HERE (example: The United States Army).
I /We grant care of the child, and temporary legal guardianship to NAME OF CAREGIVER, of ADDRESS, who can be reached at PHONE NUMBER.
This paper assigns guardianship of the children, temporarily to ________________________ (civilian on base or nearby who can take immediate physical custody) with legal authority to care for my/our child(ren) until the designated long-term guardian named above can arrive, and take then to the location pre-appointed, until my/our return.
Funds needed to support CHILDREN NAMES can be withdrawn from a bank account, established for such a purpose, at BANK, in the names of NAMES. This can be accessed via the following account number: NUMBER and PIN: NUMBER. Personal security information which is known to the guardian may also be necessary to gain access for the first time.
Documentation that relate to my child’s identification and care, including IDs, insurance cards, school records, medical data, and other pertinent personal information will be given to the guardian in advance, as is appropriate, or will be given to the oldest child to deliver, at the time of deployment.
Those persons action on behalf of, and managing care of my child(ren), have sufficient legal authority to access military facilities and services in behalf of my child(ren).
In case of emergency, please have the Red Cross reach my unit commander, so that rectification can be arranged, this contact is as follows.
Rear Detachment Commander
Family Assistance Center
Signed
Rank
Branch
MOS
I would approach an active duty military personnel who was resistant by helping them to understand why the inclusion of details, and the specificity of the family care plan is important. It provides the details necessary to provide comprehensive care to family members. Leaving details out could not only result in separation from the military branch of service a member of the military was engaged in, but could, more tragically, result in a poor level of care of the children in an emergency deployment situation. The more complete, or more through that a care plan is, the better prepared the family is in case of separation. Also, by using legal language to deal with the process, it can remove some of the emotion, helping the resistant parent to provide the legal details necessary to protect their children. However, it is important that this be done in a compassionate manner.
References:
US Army. (2016). Family Care Plans Made Easy. Retrieved from http://www.me.ngb.army.mil/Family/documents/Family-Care-Plans.ppt
