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California AD 524 Adoption Applicant Physical Exam

California adoption home studies include a physician's report on each applicant's health. On the AD 524 the doctor checks off medical history, records a physical exam and basic labs, answers questions about infertility, lists medications, and gives an opinion on whether any condition affects life expectancy or ability to parent and whether they would recommend the patient as an adoptive parent.

Who completes it

The applicant's physician completes Sections I to IV and signs. The applicant signs the release at the top naming the licensed adoption agency or CDSS Adoptions Branch district office, and signs the optional HIV disclosure authorization only if they choose to.

Submitting and payment

How to submit it
Mail the completed form directly to the adoption agency or CDSS district office named in the release; authorized HIV results go to the agency and the county Superior Court named in that section.
Who pays
The form sets no fee and does not say who pays for the examination.

Good to know

  • The form is bilingual: the patient's release and the optional HIV authorization are printed in English and Spanish, while the physician's sections are in English.
  • Section III asks about infertility treatment, whether its medical basis is known, and whether pregnancy would be possible with treatment.
  • The physician rates the applicant's likely adjustment to an adoptive placement as excellent, good, fair, questionable or don't know, and says how long they have known the patient.
  • The HIV test and disclosure are optional and covered by a separate authorization citing Health and Safety Code section 199.21(g).

Get the official form

Download the current version from the source each time; forms change without notice.

Physician's Examination of Adoption Applicant/Petitioner

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Is the AD 524 available in Spanish?

It is a single bilingual form, labeled AD 524 (BI). The applicant's authorizations, including the optional HIV disclosure, appear in both English and Spanish. The medical history, exam and opinion questions the physician answers are printed in English.

Does the AD 524 require an HIV test?

No. The HIV test and the authorization to disclose its result are optional. If the applicant signs that section, the physician records the test date and finding and sends the result to the named adoption agency and the county Superior Court for the adoption proceeding.

Where do I send the completed AD 524?

Mail it directly to the licensed adoption agency or CDSS Adoptions Branch district office the applicant named in the release at the top. The bottom of the physician's section has a 'Please mail directly to' line for that office.