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Rheoliadau Asiantaethau Mabwysiadu (Cymru) 2005

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Rheoliad 26(3)(a)

RHAN 2GWYBODAETH AM IECHYD Y DARPAR FABWYSIADYDD

1.  Enw, dyddiad geni, rhyw, pwysau a thaldra.

2.  Hanes iechyd y teulu, sy'n ymwneud â'r rhieni, brodyr a chwiorydd (os oes rhai) a phlant (os oes rhai) y darpar fabwysiadydd, gyda manylion unrhyw salwch corfforol difrifol neu salwch meddwl difrifol a chlefyd neu anhwylder etifeddol.

3.  Anffrwythlondeb neu resymau dros beidio â chael plant (os yw'n gymwys).

4.  Hanes iechyd yn y gorffennol, gan gynnwys manylion unrhyw salwch corfforol difrifol neu salwch meddwl difrifol, anabledd, damwain, derbyn i ysbyty neu fynd i adran cleifion allanol, ac ym mhob achos y driniaeth a gafwyd.

5.  Hanes obstetrig (os yw'n gymwys).

6.  Manylion unrhyw salwch presennol, gan gynnwys y driniaeth a'r prognosis.

7.  Archwiliad meddygol llawn.

8.  Manylion o unrhyw yfed alcohol a all beri pryder neu a yw'r darpar fabwysiadydd yn ysmygu neu'n defnyddio cyffuriau sy'n creu caethiwed.

9.  Unrhyw wybodaeth berthnasol arall y mae'r asiantaeth yn ystyried a all gynorthwyo'r panel.

10.  Llofnod, enw, cyfeiriad, a chymwysterau'r ymarferydd meddygol cofrestredig a baratôdd yr adroddiad, dyddiad yr adroddiad a'r archwiliadau a wnaed ynghyd ag enw a chyfeiriad unrhyw feddyg arall a all roi gwybodaeth bellach am unrhyw rai o'r materion uchod.

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