Louisiana Children’s Code 1125 – Statement of family history; contents; form
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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