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Oregon Health & Science University Knight Cancer Institute Cancer Genetics Family History Questionnaire Updated 7/27/16 Instructions: 1) Please list all your blood relatives, (including living and

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How to fill out family history questionnaire

01

Start by gathering information about your immediate family members such as parents, siblings, and children.

02

Ask family members about any significant medical conditions or diseases that run in the family.

03

Fill out the personal details section of the questionnaire, including your name, date of birth, and contact information.

04

Use the provided sections to record information about each family member's medical history, including any diagnoses, surgeries, or hospitalizations.

05

Include details about any known genetic conditions or hereditary diseases that have been prevalent in your family.

06

Provide information about lifestyle factors such as smoking, alcohol consumption, and physical activity.

07

Review the completed questionnaire for accuracy and completeness.

08

Submit the filled-out family history questionnaire to the relevant healthcare provider or institution.

Who needs family history questionnaire?

01

Anyone who is seeking medical care or undergoing a medical evaluation can benefit from a family history questionnaire.

02

Individuals who have a family history of certain medical conditions or genetic disorders may be specifically asked to fill out a family history questionnaire.

03

Healthcare providers can also use family history questionnaires to assess an individual's risk for certain diseases or conditions.

04

Researchers and scientists studying genetic factors in health and disease may also require family history questionnaires from study participants.

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What is family history questionnaire?

Family history questionnaire is a form used to gather information about an individual's family history including medical conditions, diseases, and genetic disorders.

Who is required to file family history questionnaire?

Family members or individuals who have been asked to provide their family medical history by a healthcare provider or researcher are required to file a family history questionnaire.

How to fill out family history questionnaire?

To fill out a family history questionnaire, individuals need to provide accurate and detailed information about their family members' medical histories including any known health conditions, diseases, or genetic disorders.

What is the purpose of family history questionnaire?

The purpose of a family history questionnaire is to help healthcare providers assess a person's risk for developing certain diseases or conditions based on their family medical history.

What information must be reported on family history questionnaire?

Information such as family members' medical conditions, diseases, age of diagnosis, cause of death, and any genetic disorders present in the family must be reported on a family history questionnaire.

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