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Family History Questionnaire
for Cancer
INSTRUCTIONS:
1. Complete the tables as shown in the examples.
2. List ALL family members, including those with and without cancer.
3. If your family is very
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How to fill out family history questionnaire
How to fill out family history questionnaire
01
Here is how you can fill out a family history questionnaire:
02
Start by gathering necessary information: Collect details about your immediate family members (parents, siblings, and children), extended family members (such as grandparents, aunts, uncles, and cousins), and their medical history.
03
Obtain accurate details: Make sure to gather accurate and up-to-date information, including names, dates of birth, and any significant medical conditions or diseases they might have experienced.
04
Consult with family members: Reach out to your relatives and ask them about their medical history. You can do this through phone calls, emails, or in-person conversations.
05
Use online resources: There are various online tools and questionnaires available that can assist you in organizing and recording the family history information. Utilize them for convenience.
06
Record the information: Fill out the family history questionnaire by entering the collected information. Ensure all the details are correctly recorded, and don't hesitate to ask for clarification if needed.
07
Update as necessary: Family history information can change over time. It is important to update the questionnaire regularly with any new information or changes in your family's medical history.
08
Share with healthcare providers: When visiting healthcare professionals or specialists, provide them with your completed family history questionnaire. This information can be valuable for assessing your risk factors and providing appropriate care and recommendations.
Who needs family history questionnaire?
01
The family history questionnaire can be beneficial for various individuals, including:
02
- Individuals with a personal or family history of certain medical conditions or diseases.
03
- Those seeking to understand their risk factors for developing hereditary or genetic conditions.
04
- People planning to start a family and wanting to assess the potential risks for their children.
05
- Individuals participating in clinical research or genetic studies where family history information may facilitate the identification of genetic markers or patterns.
06
- Healthcare providers and medical professionals who utilize family history to assess the risk factors and provide personalized healthcare recommendations.
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What is family history questionnaire?
A family history questionnaire is a tool used to collect information about a person's family health and medical history.
Who is required to file family history questionnaire?
Individuals who are advised by their healthcare provider to provide a family history questionnaire are required to file it.
How to fill out family history questionnaire?
To fill out a family history questionnaire, one should provide details about medical conditions, diseases, and treatments that have occurred within their family.
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 of developing certain health conditions based on their family's medical history.
What information must be reported on family history questionnaire?
Information on family medical conditions, diseases, treatments, and any significant health events must be reported on a family history questionnaire.
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