Form 04AF017E (DCFS-42). Family Health History 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the names of the applicant father and mother at the top of the form. Ensure that you provide accurate names as this information is crucial for identification.
3. Fill in your address and county of residence. This helps in establishing your location for any follow-up processes.
4. In the health history section, check all applicable boxes regarding treatments received by both parents. This includes conditions like arthritis, heart disease, and more. Be thorough to ensure complete health history.
5. If applicable, indicate whether any children in your household have received psychological counseling or treatment for major health conditions. Provide their names if you answer 'Yes'.
6. For each checked condition, complete the additional information section detailing dates, treatments, and results.
7. List all medications currently taken by both parents along with dosages and frequencies. This is important for understanding ongoing health management.
8. Finally, ensure both parents sign and date the form at the bottom before submission.

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