Enclosure (1) to COMDTINST 6010.2B
WAIVER REQUEST FOR AUXILIARY HEALTH CARE PROVIDERS
RESIDING GREATER THAN 50 MILES FROM AN
ASSIGNED CLINIC/SICKBAY
CG Auxiliarist Support to CG Health Care Facilities, COMDTINST 6010.2B prohibits the accession of
Auxiliary Health Care providers from being utilized at CG clinics or sickbays that are greater than 50
miles from where the Auxiliarist resides without a waiver from Commandant (CG-11).
1. Date:
2. Clinic, Sickbay or MLC (k) requesting waiver:
3. Clinic, Sickbay or MLC (k) representative:
4. CG Auxiliarist being considered for waiver:
5. Specialty of Auxiliarist:
6. What are the specific needs of the clinic or sickbay requesting this Auxiliarist?
7. What are the anticipated frequency and/or duration of such need?
8. How will the Auxiliarist be funded for travel to meet this need?
_____ By the Unit
_____ By MLC (k)
_____ By the Auxiliarist (at own expense)
9. By signing below, the CG Auxiliarist agrees to provide services as noted in the above requirements
of this waiver request.
_____________________________________
__________________
Signature of CG Auxiliarist
Date of Signature
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