Missouri Birth Parent Medical History Form (MO 580-3141 (VS-901A) cover sheet; MO 580-3142 (VS-901B) form)
Official state formAdoptionForm MO 580-3141 (VS-901A) cover sheet; MO 580-3142 (VS-901B) formFree downloadLast verified November 10, 2026
Lets a birth parent place family medical history in the sealed adoption file kept by the Bureau of Vital Records. It is released on request to the adoptee or the adoptee's attorney.
Who can use this form
- A birth parent
- The information must be about the birth parent and blood relatives
What to send with it
- The cover sheet and the medical history form
- Updated forms may be sent at any time to the same address
- The form prints the P.O. Box address; the office's order page says to submit to 930 Wildwood Drive, Jefferson City, MO 65109
Where to send it
- Mail to
- Bureau of Vital Records P.O. Box 570 Jefferson City, MO 65102-0570
- State fee
- No fee is printed on the form. The office's order page says to submit the forms along with applicable fees, without giving an amount.
- Typical processing
- Not provided
- Form revision
- 8-16
- Source
- Official government page