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Military dependency s Form: What You Should Know

The name and SSN of the applicant does not change. I am 18 years of age or older, a United States citizen, and have full power of attorney to make health care decisions for myself and my dependents. I understand and acknowledge, that the Federal Government does not have the right to ask information from health care providers that are not subject to HIPAA laws; nor do they have the right to ask questions of a person in such care that are not protected under Federal law or a court order. Furthermore, I affirm and certify that I am not an enemy of the United States. Furthermore, I agree, through my natural father, to be bound by the conditions of Military Service at the time of such service, and to be so bound to all the laws administered by the Office of Discharge Review. The discharge authority shall have no liability for failure to carry this obligation for the period required. I acknowledge, under penalties of perjury, that I have been interviewed by the VA Office of Discharge Review to obtain approval for this application, and it was approved. I acknowledge that this application and the answers thereto are true, correct (as well as complete) to the best of my knowledge and belief. Furthermore, I understand that the application is a statement of service with the U.S. armed forces, and I acknowledge that I am responsible for providing the required documentation to the Department of Defense. Furthermore, I understand that the information submitted in this form will be held in confidence by the Government for the sole use of the Department of Defense in accordance with my agreement. If I am required to perform active duty for more than 45 days, I will provide proof of such service including my DD‑214. Any other additional documentation relating to my discharge from the Armed Forces under any other section of law is required, or I will forfeit any benefits to which I may be otherwise entitled. All documents are sworn to before me. Signed If you are a military dependent, you will need to complete the form in this format.

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Video instructions and help with filling out and completing Military dependency forms

Instructions and Help about Military dependency forms

In October of 2016, Juliet Dilarosa was undergoing Air Force basic training. Her father is an Army Major, her grandfather and great-grandfather also served in the military. As part of her screening for air traffic control, she was called in for a medical evaluation, including behavioral health. A few weeks later, Juliet was involuntarily discharged from the Air Force and accused of fraudulent enlistment. This bewildered both her and her parents, who requested copies of her medical records. To their surprise, they discovered notations about Juliet's mental health history, of which they had no prior knowledge. Concerned, the Dilarosa family decided to review the medical records of Juliet's sister, Samantha, before she enlisted in the Army. They found similar notations indicating past behavioral health issues. Samantha truthfully disclosed this information during her enlistment process, but the Army denied her enlistment and waiver request. This story highlights a significant issue for military families. While parents are encouraged to seek behavioral health counseling for their children, they may not realize that their dependent's medical records as children merge with their active-duty service records. They argue that civilians joining the military do not have their prior medical records accessible to the military. The Air Force maintains that they encourage seeking help but require recruits to be honest during the enlistment process. The Dilarosa family emphasizes the need for military parents to understand the potential content in their child's records. They also urge military personnel to consider the unique situation of dependent children when evaluating their suitability for military service. Additionally, they hope medical providers will comprehend the impact of their notations on a child's future enlistment prospects. At present, both Juliet and Samantha have been cleared by multiple Department of Defense (DoD) and civilian mental health providers. They are currently stationed in South Korea with their parents...