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Get In State Form 13342 2008-2025

6204 INDIANA ADOPTION MEDICAL HISTORY REGISTRY State Form 13342 (R3 / 9-08) Sections A and B are CONFIDENTIAL and are for the use of the State Registrar and the Indiana Adoption Medical History registry only. Sections A and B will never be reproduced when making a copy of the medical history. STATE OFFICE USE ONLY SECTION A - BIRTH INFORMATION 1. Name of child at birth (first, middle, last) 2. Date of birth (month, day, year) 3. Sex 4. Place of birth (city, county, state) 5. Additional inf.

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