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NY OCFS-5200D Adoptive Applicant Medical Report

New York agencies approving adoptive parents (adoption only, not foster care) need a medical report on each applicant and household member. The practitioner answers screening questions, records a general health review and finds whether the applicant is in such physical condition that they can be expected to live to the child's majority with the energy needed to parent.

Who completes it

A physician, physician assistant, nurse practitioner or other licensed and qualified health care practitioner completes Section 3 for each applicant. The applicant (or household member) completes Section 1 and its release, and the home finder or agency worker completes Section 2 before handing the form over.

Submitting and payment

How to submit it
The form tells the medical care provider to return the completed report to the agency contact listed in Section 2, usually the home finder or agency worker.

Good to know

  • The report must cover a physical examination conducted not more than one year before the date the application is submitted to the agency.
  • Section 3 asks about chronic or serious disorders under treatment, current medications, and referrals for medical, mental health or alcohol and substance abuse services, with an explanation for any 'yes'.
  • The general health review records exam date, height, weight, blood pressure, vision, hearing and cardiovascular, pulmonary, GI, endocrine, nervous, musculoskeletal and skin findings.
  • Pages 3 and 4 are Part Two, the Household Member Medical Report, completed separately for each household member; edition OCFS-5200D (10/2020).

Get the official form

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

Adoptive Applicant Medical Report (Part One) - Adoption Only

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

What finding does the practitioner make on OCFS-5200D?

The practitioner states that, based on their findings and knowledge of the individual, the applicant IS or IS NOT in such physical condition that it is reasonable to expect them to live to the child's majority and have the energy and other abilities needed to fulfill parental responsibilities, with an explanation if not.

Do household members need their own medical report?

Yes. Part Two of OCFS-5200D is a Household Member Medical Report. The agency must obtain a report showing each household member is free from communicable disease, infection or illness, or any condition that might affect proper care of an adopted child. The applicant completes Section 1 for members under 18.

Is OCFS-5200D used for foster parents?

No. OCFS-5200D is marked Adoption Only. Foster parent and foster/adoptive parent applicants use OCFS-5183D, the Foster/Adoptive Applicant Medical Report, which is part of the OCFS-5183 home study form set and also requires an exam within one year.