Health Evaluation (Medical) Report
The CCAA requires that you fill out a standard, two page Health
Evaluation form for each adult member of the household. Instead of that
nice, easy letter of good health used in the past (and no longer necessary), your
doctor now needs to fill out a form which might require a more extensive medical
exam. You no longer need a separate letter of good health.
The medical forms are valid within 12 months from the date
of the exam to the date of registration of documents at the CCAA. This means that
the date of the exam must be within 12 months of the date your dossier is received by the
CCAA.
As part of the the standardized form, there is a section labeled "Physician's
Statement". Make sure your doctor writes a sentence or two under the heading
"Physician's Statement" that is similar to the following:
(adoptive parent) is in good health and has a normal life
expectancy. (adoptive parent) is free of all infectious diseases, and is capable,
physically and emotionally, to adopt and raise a child.
Let's clarify this. The Physician Statement above is
included on the form, and should not be included as a separate letter/attachment.
Some families are providing a letter as well as the medical form, and that is not
necessary.
You'll need a completed Health Evaluation form for each
adoptive parent for your dossier. As with everything else with your dossier,
have it notarized, certified and authenticated.
Your home study will also require a medical. Ask your home study agency
if the CCAA medical form is acceptable for them. If so you can use that one form for
both your dossier and the home study (check with your agency to see if they need a signed
copy or if a photocopy will do).
If your agency requires you to use their medical form for the home
study, then take both forms with you to your doctor and ask him to complete both at once;
this will save you and your doctor some time. Ideally your doctor's signature should be
notarized, but if that is really impossible you can attach a notarized cover letter signed
by you, to your medical form.
An image of the 2 page form is displayed below the guidelines (they may
take a few seconds to load the first time).
Guidelines to help you, and your doctor, fill out the Health
Evaluation form
IMPORTANT: The CCAA now requires
that all additional adult household members (18 years and older) also have a medical.
Those must be be certified and authenticated, since they are now required as part
of your dossier.
- If you are currently taking any medication, the name of the medicine,
dosage and reason prescribed must be recorded in the medical exam.
- If you have any long-term physical/mental illness or condition, or have
undergone any operations, your doctor will need to write a letter which covers the
following criteria for each condition/occurrence:
a. Define the illness/condition
b. Summarize the your history with the illness/condition
c. Outline the treatment, both historically and ongoing
d. Outline your recovery, and current health status
e. Provide a prognosis for your likelihood for continued health.
f. Provide a recommendation that the individual would be able to adequately care for an
adopted child.
- Questions on the medical form must be based on a medical examination by
your physician no more than 6 months prior to the date of the report. Results of basic
blood tests and urinalysis should be included, as well as testing for AIDS. Please
note: The AIDS test is absolutely required.
- If possible, have this form printed onto your doctor's letterhead. If
that's not possible, the top of the form can be left blank or have the doctor's office
type in at the top, the name and address of the doctor or the practice. You can download a zipped Microsoft Word version of this form here,
or simply click on either image, page 1 or page 2 below.
- Make sure that every question is answered - no blanks or N/A's.
Even if the answer is vague or incomplete, have your doctor fill in something.
- Under "Physician's Statement", the doctor should write a
general statement about your health, life expectancy and ability to raise a child. You can
use the following wording or something to the same effect:
(adoptive parent) is in good health and has a normal life expectancy. (adoptive
parent) is free of all infectious diseases, and is capable, physically and emotionally, to
adopt and raise a child.
- All results and statements should be either typed or neatly printed,
including the name and address of the physician, in addition to, of course, his
signature. The doctor's handwriting on the form must be legible and will be rejected
if not readable.
- Blood work and urinalysis, including testing for AIDS must be based on a
medical examination performed within the last 6 months. Apart from that, we see no need
for any other invasive testing unless your doctor thinks that it's necessary. Most of the
report can probably be filled out with a knowledge of your medical history and some less
intrusive testing such as blood pressure, vision, hearing, etc. again as long as it
occurred within the previous 6 months.
- This form is a new requirement. Therefore, there may be some changes, of
which we will inform you as we learn of them.
Health Evaluation Form Required by the CCAA - Page 1
Health Evaluation Form Required by the CCAA - Page 2
