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ODDS 1653 (9/96), Page 1 of 2MEDICAL STATEMENT FOR FOSTER CARE/ADOPTIVE APPLICANT AND ALL HOUSEHOLD MEMBERS Name (LAST, FIRST, MIDDLE)Date of BirthAddress (Street, City, State and ZIP) 1. Have you
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Obtain the Justia medical statement form.
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Fill out your personal information in the designated sections, such as your name, address, and contact information.
03
Provide details about your medical history, including any current medications you are taking and past medical conditions.
04
Describe your current medical condition or reason for needing the medical statement.
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If applicable, have your healthcare provider or physician complete and sign the form.
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Review the completed form for accuracy before submitting it as needed.

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People who require documentation of their medical history or current medical condition for legal purposes.
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Individuals applying for disability benefits or requesting accommodations at work or school.
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Patients undergoing medical treatment who need to provide information to healthcare providers or insurance companies.
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Justia medical statement is for providing medical information related to a legal case or situation.
The individuals involved in a legal case or situation may be required to file a justia medical statement.
Justia medical statement should be filled out with accurate and detailed medical information relevant to the legal case.
The purpose of justia medical statement is to provide medical evidence and information to support or defend a legal case.
Justia medical statement should include detailed medical history, diagnosis, treatment, and prognosis related to the legal case.
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