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NY OCFS-5183D Foster/Adoptive Applicant Medical Report

New York foster parent and foster/adoptive parent applicants need a medical report based on a physical exam within one year before they can be certified or approved, and again at reauthorization. OCFS-5183D is that report in the OCFS-5183 home study form set: the applicant and agency identify themselves, and the practitioner completes a health review and statement.

Who completes it

A physician, physician assistant, nurse practitioner or other licensed and qualified health care practitioner completes Section 3, the health review and practitioner statement. The applicant completes Section 1 and the certifying or approving agency completes Section 2.

Submitting and payment

How to submit it
Return the completed report to the agency named in Section 2, which may be the local department of social services or a voluntary foster care agency.

Good to know

  • The physical exam behind the report must have taken place within one year; the same report is required again when the home is reauthorized.
  • OCFS posts the form as a Word document (.docx) with fillable fields rather than a PDF, so it can be typed before printing and signing.
  • Applicants approved for adoption only use a different form, OCFS-5200D, Adoptive Applicant Medical Report (Part One).
  • Check the agency contact in Section 2 before returning the report, since certification can be handled by either a county department or a voluntary agency.

Get the official form

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

Foster/Adoptive Applicant Medical Report (Part One)

Official pageWord file

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Frequently asked questions

Who can complete OCFS-5183D?

A physician, physician assistant, nurse practitioner or other licensed and qualified health care practitioner completes Section 3. The applicant fills in Section 1 and the certifying or approving agency fills in Section 2, so the practitioner's part is the health review and statement.

How recent must the exam be for OCFS-5183D?

The report must be based on a physical examination within one year. It is required for certification or approval of foster and foster/adoptive parent applicants, and again at reauthorization of the home.

What is the difference between OCFS-5183D and OCFS-5200D?

OCFS-5183D is part of the foster and foster/adoptive home study set (OCFS-5183). OCFS-5200D is the medical report for applicants seeking approval for adoption only. Both are completed by a physician, PA, NP or other licensed practitioner in Section 3.