10-146-12 Me. Code R. § III

Current through 2024-51, December 18, 2024

Section 146-12-III - MEDICAL HISTORY AND CONTACT PREFERENCE

A. All forms and fees that are not compliant with these rules will be returned to the applicant if possible. Forms that cannot be returned will be destroyed.

B. The Medical History Form and Contact Preference Form shall be available upon the State Registrar's website and are also available in paper format upon request of the State Registrar.

C. Medical History Form

1. The Medical History Form must contain the following data elements to be completed by the birth parent(s):

a. Full name of the adoptee at birth;

b. Year of birth of the adoptee;

c. Sex of the adoptee;

d. Medical conditions of the adoptee's biological family;

i. Respiratory

ii. Gastrointestinal

iii. Cardiovascular

iv. Immune/Hematological

v. Renal

vi. Liver Disease

vii. Central Nervous System

viii. Endocrine

ix. Muscular/Skeletal

x. Neuromuscular

xi. Visual/Auditory/Speech

xii. Other Conditions

xiii. Drug and alcohol use during pregnancy

xiv. Other information on birth parents.

2. If available, upon request a photocopy of the medical history form will be issued to the applicant pursuant to 22 M.R.S.A. §2768(1)-(4).

D. Contact Preference Form

1. The Contact Preference Form must contain the following statements and data elements to be provided by the birth parent(s):

a. Full name of the adoptee;

b. Year of birth of the adoptee;

c. Sex of the adoptee;

d. The birth parent(s) must respond to only one of the following statements:

i. I would like to be contacted. I have completed this contact preference form and a medical history form and am filing them with the State Registrar of Vital Statistics.

ii. I would prefer to be contacted only through an intermediary. I have completed this contact preference form and a medical history form and am filing them with the State Registrar of Vital Statistics.

iii. Do not contact me. I may change this preference by filling out another contact preference form. I have completed this contact preference form and a medical history form and am filing them with the State Registrar of Vital Statistics.

e. The current name, current mailing address, and telephone number of the birth parent(s) if contact is requested.

2. If available, information regarding the contact preference form will be issued to the applicant pursuant to 22 M.R.S.A. §2768(1)-(4).

10-146 C.M.R. ch. 12, § III