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Indiana adoption medical history report 2026
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- Click ‘Get Form’ to open the Indiana Adoption Medical History Report in the editor.
- Begin with Section I - Affirmation. Type or print your name, date of birth, and mailing address in black ink. Ensure you provide a written signature affirming the accuracy of the medical history.
- Proceed to Section II - Medical History. Here, you will find checkboxes for various medical conditions. Mark an 'X' in the appropriate boxes for the birth mother, father, and adopted person as applicable.
- For each condition listed from Items 1 through 6, provide additional details in the designated section if necessary. This may include information about congenital conditions or significant family medical history.
- If more space is needed for details, use plain white paper labeled with 'Item/Details' and ensure it includes page numbers. Remember to keep all information confidential and avoid identifying details.
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form 9966
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This report reflects the health status and medical history of the adoptee and the adoptees birth parents but contains no identifying information. AdoptionsRead more
(f) An adoptive parent may request a waiver of any record based on the results of a criminal history check conducted under IC 31-9-2-22.5, applicable to theRead more