Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to access the form and open it in your editor.
2. Begin filling in Section I with information about the birth parent and the child placed for adoption. Include the child's name, birthdate, and birthplace, along with the birth parent's relevant details such as name, birthdate, and contact information.
3. In Section II, provide details about the individual providing information on behalf of the birth parent. Include their name, address, telephone number, and relationship to the child.
4. Section III requires you to describe the birth parent and their parents, including names, birthdates, height and weight, ethnic background, and education completed. Be sure to indicate if any of the parents are deceased.
5. Move to Section IV to detail the birth parent's siblings, including names, relationships, gender, and relevant medical information, using additional sheets if necessary.
6. In Section V, describe the birth parent's grandparents with their names, height, weight, ethnic background, education completed, and any information on whether they are deceased.
7. Section VI requires the listing of the birth parent's other children, detailing their names, relationships, birthdates, and health or medical issues, with additional space provided for more entries if needed.
8. Proceed to Section VII to complete the medical and genetic history section by indicating any medical conditions in the child or their blood relatives, using the specified codes for relationships.
9. Finally, in Section VIII, provide authorization for the necessary disclosures related to medical and genetic information. Sign and date the form.
10. After completing the form, ensure to review all entries for accuracy before saving changes. You can then download, print, or share the form as needed.

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