Question Please choose If yes please comment Would you be interested in 5 participating in EFMP recreational activities? Do you plan to participate in the 6 Respite Care Reimbursement Program? Housing Question Please choose If yes please comment Will your family be requesting 7 installation or Public Private Venture (PPV) housing? Does your family qualify for 8 priority housing? Does your EFM require 9 accommodations or modifications for housing? Have you already applied for 10 housing? Do you have any pets? 11 Do you have any service 12 animals? Travel Please choose Question If yes please comment Do you have a calendar? my Move” can be found at: “Plan 13 Medical Please choose If yes please comment Question Are all medication prescriptions 14 filled w/refills? Do you have copies of your 15 EFM’s medical records? Have you transferred your ? 16 Have you transferred your 17 Tricare and/or ECHO Case Manager? Do you have the gaining location 18 doctors established? Will you need doctor 19 appointments within 30 days of your arrival? School Question Please choose If yes please comment SCOR can be found at: Do you have a ecord (SCOR) 20 notebook?
Question Please choose If yes please comment 5 Would you be interested in participating in EFMP recreational activities? 6 Do you plan to participate in the Respite Care Reimbursement Program? Housing Question Please choose If yes please comment 7 Will your family be requesting installation or Public Private Venture (PPV) housing? 8 Does your family qualify for priority housing? 9 Does your EFM require accommodations or modifications for housing? 10 Have you already applied for housing? 11 Do you have any pets? 12 Do you have any service animals? Travel Question Please choose If yes please comment 13 Do you have a calendar? “Plan my Move” can be found at: Medical Question Please choose If yes please comment 14 Are all medication prescriptions filled w/refills? 15 Do you have copies of your EFM’s medical records? 16 Have you transferred your ? 17 Have you transferred your Tricare and/or ECHO Case Manager? 18 Do you have the gaining location doctors established? 19 Will you need doctor appointments within 30 days of your arrival? School Question Please choose If yes please comment 20 Do you have a ecord (SCOR) notebook? SCOR can be found at:
EFMP_PCS_Needs_Assessment_Fillable_2017.docx