Indiana Application for Search of Medical History Information for Adoptee (State Form 47261)

Who can use this form

• The applicant must state their relationship to the adoptee.
• The applicant signs under the penalties for perjury.
• The form says medical history is unlikely to be on file for adoptions before January 1, 1986.

What to send with it

• The completed and signed application.
• A $25.00 check or money order per application, payable to the Indiana Department of Health.
• A copy of a valid government, state, or military identification. The address must match the address on the application.

Where to send it

Mail to

Indiana Department of Health Division of Vital Records B-4 Attention: Medical History 2 North Meridian Street Indianapolis, IN 46204

State fee

$25.00 per application.

Typical processing

The form says to allow 30 days. The office's page lists 120 days for adoption history requests.

Form revision

R5 / 1-24

Source

Official government page