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Terms Used In Louisiana Children's Code 1125

            A. The Statement of Family History shall contain the following nonidentifying information, if known:

            (1) The age of each biological parent.

            (2) Descriptive information about each biological parent.

            (3) The biological relationship between parents, if applicable.

            (4) Explicit and extensive medical genetic history of each biological parent and his parents, siblings, grandparents, great-grandparents, aunts, uncles, and cousins.

STATEMENT OF FAMILY HISTORY

Child’s Biological MOTHER

Child’s Biological FATHER

Does the child have or has the child had any other serious illnesses or medical conditions?