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Illinois DCFS CFS 604 Foster Parent Medical Evaluation

Illinois DCFS licenses foster and adoptive homes only after a physician evaluates each adult who will care for children. On the CFS 604 the doctor summarizes health problems, progressive or terminal conditions, medications, recent hospitalizations and substance use, records TB and immunization status, and rates physical capabilities such as lifting a child, then certifies freedom from communicable disease and ability to parent.

Who completes it

The physician treating or examining the adult completes the whole form and signs with their state license number.

Submitting and payment

How to submit it
Return it to the licensing agency, DCFS or the private child welfare agency, where it is kept in a sealed envelope marked confidential in the licensing file.
Who pays
The form sets no fee and does not say who pays for the evaluation.

Good to know

  • The physician assesses ability to care for up to six children aged 0 to 18, now and for the foreseeable future of five to ten years.
  • It asks whether the adult has had Tdap and a flu vaccine in the past year, with the date or the reason if not.
  • Capability questions include lifting a child under 6 months and up to 3 years, walking 50 to 100 feet, and medically complex care such as suctioning or nebulizers.
  • A tuberculin test result is required at the initial exam only, with a chest X-ray if necessary.

Get the official form

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

Medical Evaluation of an Adult in a Foster or Adoptive Home

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

Who signs the Illinois CFS 604?

The physician who treats or examined the adult. They state how long they have treated the patient, complete the history, immunization, exam and capability sections, certify freedom from communicable disease symptoms and the absence of limitations that would prevent parenting, then sign with their state license number.

Does the CFS 604 ask about vaccinations?

Yes. It asks whether the adult has received Tdap and a flu vaccination over the past year, recording the date received or the reason if not. The answers go to the licensing worker with the rest of the evaluation.

What physical abilities does the CFS 604 cover?

Lifting a child under 6 months and from 6 months to 3 years, walking 50 to 100 feet, bending, kneeling and reaching, any assistive device, and tasks for a medically complex child such as lifting from bed to chair, frequent feedings, suctioning, monitoring, medications, nebulizations and treatments.