My Personal Bio

York, Alana H.
PV2/E-2
123-45-6789
31 January 2011
201st BFSB/C Co 109th MI BN
SPC Rubi, Caitlin/Team member
This is your counseling for pregnancy:

The purpose of this counseling is to inform PV2 York, Alana of her options for dishonerable discharge, what to expect as well as her responsibilies while still enlisted and resources she may use to receive help.

Preparing a Family Care Packet - Within your 7th month of pregnancy SM will need to start preparing a family care packet and complete a DA Form 5841 - Power of Attorney (You will need two, 1 for the short term provider and 1 for the long term provider unless of course it’s the same person… This POA is specifically for the FCP)

Profile - AR40-501 7-9. Profiling pregnant soldiers - SM will seek medical confirmation of pregnancy and will comply with the instructions of medical personnel and the invidual's unit commander. Profiles will be issued for the durations of the pregnancy. SM should ensure that the unit commander is provided a copy of the profile, and advise the unit commander as required. Upon termination of pregnancy, a new profile will be issued reflecting revised profile information.

Physical Fitness - SM will not be subject to body composition testing until at least six months after giving birth.

Work hours as outlined in profile - AR40-501 7-12.

Uniforms - SM may contact her unit supply sergeant to acquire maternity uniforms.

Pregnancy discharge (AR 635-200, Chapter 8).

Non-deployable status - SM will have 1 year non-deployable status for 1 year after the birth

Housing - 253-967-3191/ Bldg 2012, Joint Base Lewis-McChord, Wa 98433 for on-post housing. 253-967-5165/ rental setion and listed properties for off-post housing.

Convalescent leave - para 5-7 AR 600-8-10/ unit commander is the approval authority for up to 42 days convalescent leave after normal pregnancy and childbirth.

Military OneSource:
Offers up to six cost-free, confidential counseling sessions to eligible military personnel and their family members. Beneficiaries can visit Military OneSource online or call 1-800-342-9647 for details.

Military and Family Life Consultants:
Provide service members and their families with face-to-face, non-medical counseling and education about daily life stressors related to deployment and reintegration. Beneficiaries can visit MHN Government Solutions online or call 1-800-646-5613 for details.

Online Behavioral Health Resource Center:
Humana Military Healthcare Services, Inc. (Humana Military) offers an online behavioral health resource center to TRICARE beneficiaries in the “Health and Wellness” section.

Start preparing a family care packet around the 7th month of pregnancy
Start doing physical fitness witht the installation's Pregnancy Physical Fitness Program group
Go through supply to get new uniforms for pregant soldiers.
Check with doctor to get understanding of the restrictions the medications may have (driving restrictions, lifting…)
Plans are to stay in the Army after having the child.
Contact housing to get on the housing list.
Keep supervisor informed of the charges in the work hours allowed by profile.

Schedule the soldier for an appointment with the company commander for her initial counseling for her family car packet (if needed)
Contact the NCOIC of the Installation's Pregnancy Physical Fitness Program to get her scheduled to start PT with them.
Coordinate the workload around the soldier's restriced work hours and other limitations.
Signature of Counselor:
Date:

Counselor:
Individual Counseled:
Date of Assessment:

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DEVELOPMENTAL COUNSELING FORM

For use of this form, see FM 22-100; the proponent agency is TRADOC

AUTHORITY:

DATA REQUIRED BY THE PRIVACY ACT OF 1974
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PRINCIPAL PURPOSE: To assist leaders in conducting and recording counseling data pertaining to subordinates.

ROUTINE USES:

For subordinate leader development IAW FM 22-100. Leaders should use this form as necessary.

DISCLOSURE:

Disclosure is voluntary.

PART I - ADMINISTRATIVE DATA

Name (Last, First, MI)

Rank/Grade

Social Security No.

Date of Counseling

Organization

Name and Title of Counselor

PART II - BACKGROUND INFORMATION

Purpose of Counseling: (Leader states the reason for the counseling, e.g., performance/professional growth or event-oriented counseling, and

includes the leader's facts and observations prior to the counseling.

PART III - SUMMARY OF COUNSELING

Complete this section during or immediately subsequent to counseling.

Key Points of Discussion:

OTHER INSTRUCTIONS
This form will be destroyed upon: reassignment (other than rehabilitative transfers), separation at ETS, or upon retirement. For separation

requirements and notification of loss of benefits/consequences see local directives and AR 635-200.

DA FORM 4856, JUN 1999

EDITION OF JUN 85 IS OBSOLETE

USAPA V1.00

USAPA V1.00

Note: Both the counselor and the individual counseled should retain a record of the counseling.

Assessment: (Did the plan of action achieve the desired results? This section is completed by both the leader and the individual counseled and provides useful information for follow-up counseling.

Leader Responsibilities: (Leader's responsibilities in implementing the plan of action).

Plan of Action: (Outlines actions that the subordinate will do after the counseling session to reach the agreed upon goal(s). The actions must be specific enough to modify or maintain the subordinate's behavior and include a specified time line for implementation and assessment (Part IV below).)

Session Closing: (The leader summarizes the key points of the session and checks if the subordinate understands the plan of action. The
Subordinate agrees/disagrees and provides remarks if appropriate.)

Individual counseled:

I agree

disagree with the information above.

Individual counseled remarks:

Signature of Individual Counseled:

Date:

I

REVERSE, DA FORM 4856, JUN 1999

PART IV – ASSESSMENT OF THE PLAN OF ACTION