South Carolina Biological Parent's Medical History Form (4021-ENG-DPH)
Official state formAdoptionForm 4021-ENG-DPHFree downloadLast verified November 10, 2026
An optional checklist a biological parent may complete to place personal and family medical history in the sealed adoption file for release to the adoptee. It is sent to the Vital Records Section with Form 4022.
Who can use this form
- A biological parent of the adoptee completes this form
- The form is optional
What to send with it
- This form, completed
- The request form (Form 4022), which the office's website says to send with it
- The consent and contact preference form (Form 4020), which the office's website says to send with it
Where to send it
- Mail to
- See the form for where to file it.
- State fee
- Not printed on the form. The office's website lists a $27 non-refundable processing fee ($12 search fee plus $15 special filing fee) for the biological parent's request package.
- Typical processing
- Not provided
- Form revision
- 07/2024
- Source
- Official government page