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4. If the preparer recommends approval of the case, the home study preparer must identify the specific characteristics

of the child for which this family is approved to adopt. The home study should provide a detailed assessment of the

suitability of the PAP(s) to the most serious degree of medical or psychological needs and age requirements for a child

who they are prepared to parent. If the home study preparer wishes to restrict the recommendation only to specific

conditions, these should be listed. See sample below:

Sample Wording:

“This worker recommends approval of Mr. and Mrs. Smith to adopt one female child, age 0-4 years at time of referral,

from Country X. I also recommend Mr. and Mrs. Smith for the adoption of one child with special needs (explain).”

OR: “The Smiths are recommended to adopt a child with minor medical needs limited to the following: low birth

weight, heart defect or murmur, webbed fingers or toes, club foot, cleft lip and/or palate, or issues that can be assisted

with orthopedic intervention.”

OR: “The Smiths are recommended to adopt a child who has Down’s syndrome or delayed motor and mental

development.”

5. The home study should also include a medical assessment of the PAP and any adult member of the household. This

assessment should address the physical, mental, and emotional health of the PAP and any adult member of the

household. The summary in the home study should cover the type of information contained in the samples below:

Sample Wording #1:

“Bradley Smith was examined by his physician, Dr. John Rhoades, on February 22, 2008. Bradley was found to be

in good physical and mental condition and is free of communicable diseases. Dr. Rhoades has indicated no history

of physical, mental, emotional health, or behavioral issues. This report was reviewed by this worker, and the above

findings are as stated. It is this worker’s assessment that Bradley is emotionally, physically, and mentally stable and

will provide a loving home for any child placed in this family. No referrals to medical or mental health professionals

were made.”

“Susan Smith was examined by her physician, Dr. Amy Rhoades, on February 22, 2008. Susan was found to be in

good physical and mental condition and is free of communicable diseases. Dr. Rhoades has indicated no history of

physical, mental, emotional health, or behavioral issues. This report was reviewed by this worker, and the above

findings are as stated. It is this worker’s assessment that Susan is emotionally, physically, and mentally stable and will

provide a loving home for any child placed in this family. No referrals to medical or mental health professionals were

made.”

Sample Wording #2:

“Mr. and Mrs. Smith are both in good health. Neither have any medical issues that would affect their ability to adopt

and parent a child.” (State basis for such conclusion.)

6. The home study should also address information relative to the PAP’s finances. This assessment should include the

following:

A. A description of the applicant’s income, financial resources, debts, and expenses; and

B. A statement identifying what evidence was considered to verify the source and amount of income and financial

resources.

Form M-738 Instructions 07/27/09 N

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Instructions For Form M-738 - Hague Home Study Tip Sheet For Adoption Service Providers And Prospective Adoptive Parents Page 2