opnavinst 5350.4 d - Navy Medicine - U.S. Navy
opnavinst 5350.4 d - Navy Medicine - U.S. Navy
opnavinst 5350.4 d - Navy Medicine - U.S. Navy
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;uhj: REQUEST FOR ADMINISTRATIVE SEPARATION WAIVER<br />
OPNAVINST <strong>5350.4</strong>D<br />
4 Jun 09<br />
r. Provide history of previous treatment(s), status of<br />
aftercare 1 ~f any) (e.g., "Member successfully completed<br />
iP~Level 1;: treatment on 28 February 2005 at ARC, Jacksonville,<br />
Jlorida. Member is currently in aftercare or member completed<br />
aftercare 3a 39 October 2005.")<br />
. insert member's history of disciplinary infractions,<br />
~~lcohoi lrlc~dents, all other alcohol related problems, and dates<br />
>f each, : r any.<br />
r:. (:ommanding officer's comrnents/endorsement (provide brief<br />
;ummary ( ~f member ' s performance) .<br />
, ;3mmanil point of contact is: (Insert name of POC, who can<br />
ne reached dt COMM number/DSN, or COMM fax number/DSN, and<br />
-2-maii address. E-mail address for command POC is required.)<br />
Commanding officer's signature<br />
(or XO/Acting or By direction)<br />
*NOTE: Sni4_osures should include NAVPERS 1070/613,<br />
Idmin~strat-ve Remarks relevance, memorandums detailing<br />
2xtrdordinary circumstances, and documentation believed to have<br />
bearing on this request. DAARs should be completed after every<br />
zommand oz self-referral, alcohol incident, and final<br />
llspositiori determination. Submit initial DAARs within 30 days<br />
~i che referral or incident. Incomplete requests cause delays<br />
LX grocess LrLc:.<br />
Contact the NADAP office for any further questions regarding<br />
iicohol waiver requests at COMM 901-874-2485/DSN 882; COMM Fax<br />
3C1-873--4228 DSN 882. )<br />
Ir~gina, _eLter from command will be mailed to:<br />
'hlet c-IF Kdval aperations (N135F)<br />
1~23 integrity Drive<br />
41ilington TK 38055<br />
'opy + i?. c'ommand Security M anager<br />
Appendix A to<br />
Enclosure (1)