Birth Parent Medical Information {CCCO 0062}

CCCO 0062 - BIRTH PARENT MEDICAL INFORMATION. The purpose of this form is to gather your health history, genetic history, and social background information to share with the adoptive parents. It is important the adoptive family provide this information to the child’s physician. It will become a part of the child’s medical and family history. The form includes questions about physical characteristics of both birth parents, their education level, occupation, hobbies, interests, and talents, as well as any disabilities they may have. It also asks about the pregnancy history and any medication or substances used during pregnancy or the year prior to pregnancy. Birth parents have the option to redact their name on the form if they do not want it to be shared with the adoptive family. www.FormsWorkflow.com