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Understand the importance of gathering a complete and accurate family medical history from your patients and find tools to simplify the process.
Complete all the fields as best you can. The form does not have to be complete but every piece of information helps. Include at least 3 generations of family members, if possible, to provide your doctors the most complete picture of your family’s medical history.
Tools. My Family Health Portrait A free, online family health history collection tool that lets you share family health history information with relatives and assess your risk for certain conditions.
Your family medical history can help you and your healthcare provider determine a diagnosis or help you avoid the risk factors that may lead to disease.
Collect information about your parents, sisters, brothers, half-sisters, half-brothers, children, grandparents, aunts, uncles, nieces, and nephews. Include information on major medical conditions, causes of death, age at disease diagnosis, age at death, and ethnic background.
Using any computer, an Internet connection and an up-to-date Web browser, you provide your health information to build a drawing of your family tree and a chart of your family health history. Both the chart and the drawing can be printed and shared with your family members and your doctor.
Family History: Please list any known medical problems for the relatives listed below: For example: diabetes, breast/colon/ovarian/ prostate cancer, heart attacks, high blood pressure, alcohol abuse, depression, skin cancer, osteoporosis.