Wisconsin requires a health examination report for each adoptive parent working with a public adoption agency, and this form meets that requirement under DCF 50.05(6)(h). After the exam, the provider records the medical history, examination findings, medications and personal habits, and gives a recommendation on anything that could affect the parent's ability to care for an adopted child until age 18. The agency files it in the adoptive family record.
A physician, nurse practitioner or physician assistant completes Sections 4 to 6 and signs; Section 3 (provider contact details) can be filled by the parent or the provider. The adoptive parent signs the Section 1 release, and agency staff complete Section 2.
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Adoptive Parent Health Report
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The instructions say each adoptive parent presents the form to a physician, nurse practitioner or physician assistant, who fills it out and signs it after the required health examination. The provider completes Sections 4, 5 and 6, and either the parent or the provider completes Section 3.
Yes. The form states that its use is required and meets the requirement of Wisconsin Administrative Code DCF 50.05(6)(h). Each adoptive parent needs a separate report, and the public adoption agency files the completed reports in the adoptive family record.
Section 6, Recommendations, asks whether, based on knowledge of the patient and the exam findings, anything would adversely affect the patient's ability to care for an adopted child. The provider checks yes or no and explains any yes, attaching more pages if needed.