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NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES Division of Social Services Adoption Health History, Part I Name of Agency Adoptee 's First Name Source of information, if not completed by parent.

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How to fill out the Dss 5103 online

Filling out the Dss 5103 form online is an essential step in the adoption process. This guide provides comprehensive instructions to assist you in accurately completing the form while ensuring that you understand each section.

Follow the steps to fill out the Dss 5103 form with ease.

  1. Click the ‘Get Form’ button to access the Dss 5103 form and open it in your chosen editor.
  2. Begin by entering your personal information, such as the agency name and the adoptee's first name. Ensure accuracy as this data is crucial for the adoption process.
  3. Proceed to fill out the birth mother's menstrual and pregnancy history. Provide details such as the mother's age at onset of menses, the usual length of periods, and the frequency of periods.
  4. In the section concerning the pregnancy, indicate the mother's age at the start of pregnancy and any complications experienced. Complete the fields regarding prenatal care, including start dates and the number of visits.
  5. Complete the delivery history section by detailing the duration of labor, type of delivery, and whether anesthesia was administered.
  6. Fill in the conditions during the pregnancy section, noting any infectious diseases, complications, or health issues faced by the mother.
  7. Continue to Part II of the form, indicating if the information pertains to the birth mother or birth father, and complete the health history for biological parents and relatives.
  8. After providing information on various health concerns, ensure that all preceding sections are accurately filled out, and review the form for completeness.
  9. Once you are satisfied with the filled-out form, you can save any changes made, download a copy for your records, print the form, or share it as needed.

Complete your Dss 5103 form online today to streamline your adoption process.

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If you are requesting information as part of an open case involving CPS, please submit the DSS-5277-ia. Requests must be submitted on your agency letterhead. A fax cover page on letterhead is acceptable. North Carolina has a state-supervised, county-administered social services system.

Moreover, the law requires that all information and records shared must be withheld from public inspection and maintained in a confidential manner. Any violation of these confidentiality requirements will be punishable as a Class 1 misdemeanor.

Call 1-800-662-7030 (English, Spanish).

If you are requesting information as part of an open case involving CPS, please submit the DSS-5277-ia. Requests must be submitted on your agency letterhead. A fax cover page on letterhead is acceptable. North Carolina has a state-supervised, county-administered social services system.

1-800-4-A-CHILD (National Child Abuse Hotline)

Mecklenburg County, NCDepartment of Social Services. Social ServicesCurrently selected. Services. About DSS. Services For Families.

CPS can remove children from the home. They need to have a court order or be able to prove that the child is in imminent danger in order to remove a child. Imminent danger could include things like physical harm, sexual contact, neglect, or firearms left in the open.

Individuals who file a complaint are notified in writing of any actions taken as a result of the complaint. Mailing Address. P.O. Box 1043. Asheboro, NC 27204. Physical Address. 1207 S. Cox Street, Suite F. Asheboro, NC 27203. Phone Numbers. Office: 336-625-1679. Fax: 336-625-4246. EMAIL US.

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