xmlns:atom="http://www.w3.org/2005/Atom"

SCHEDULE 1

Regulation 16(2)

PART 5PARTICULARS RELATING TO THE HEALTH OF THE CHILD'S NATURAL PARENTS AND BROTHERS AND SISTERS

1.  Name, date of birth, gender, weight and height of each natural parent.

2.  A family health history, covering each of the child’s natural parents, the child’s brothers and sisters (if any) and the other children (if any) of each parent with details of any serious physical or mental illness and any hereditary disease or disorder.

3.  A health history of each of the child’s natural parents, including details of any serious physical or mental illness, drug or alcohol misuse, disability, accident or hospital admission and in each case any treatment given where the agency consider such information to be relevant.

4.  A summary of the mother’s obstetric history, including any problems in the ante-natal, labour and post-natal periods, with the results of any tests carried out during or immediately after pregnancy.

5.  Details of any present illness, including treatment and prognosis.

6.  Any other relevant information which the agency considers may assist the panel.

7.  The signature, name, address, telephone number and qualifications of any registered medical practitioner who supplied any of the information in this Part together with the name and address of any other doctor who may be able to provide further information about any of the above matters.