Get the free family history form - BC Cancer

PLEASE PRINT CLEARLY Page 1 of 6BCCA Chart #: FAMILY HISTORY FORM Today's Date: Name: Birth Date: The information on this form will help us make the best use of your time during your appointment with

How to fill out family history form

How to fill out family history form

1. Start by gathering all the necessary information about your family members, such as their names, dates of birth, and any known medical conditions or illnesses they have had.
2. Organize the form by creating a section for each family member, including yourself.
3. For each family member, fill in their personal details, including their full name, date of birth, gender, and contact information.
4. In the medical history section, provide details about any known medical conditions, such as diabetes, heart disease, cancer, or genetic disorders, that each family member has or had.
5. Include information about any surgeries or major illnesses that each family member has undergone.
6. If there is a history of mental health disorders in your family, make sure to mention it.
7. Note any medications that are being or have been taken by family members.
8. If any family member has passed away, indicate the cause of death and their age at the time.
9. Don't forget to sign and date the form once it is complete.
10. Keep a copy of the filled-out family history form for your records.

Who needs family history form?

1. Family history forms are typically needed by individuals who are seeking medical care or genetic counseling.
2. Doctors, nurses, and other healthcare providers may request family history forms to assess the risk of certain diseases and plan appropriate treatments.
3. Individuals who want to understand their own health risks and potential hereditary conditions may also find family history forms useful.
4. In some cases, family history forms are required for research studies or clinical trials related to genetics and inherited diseases.

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What is family history form?

Family history form is a document used to track and record information about a person's family medical history.

Who is required to file family history form?

Family members or individuals with a history of certain medical conditions are typically required to file a family history form.

How to fill out family history form?

Individuals can fill out a family history form by providing details about their immediate family members, including any known medical conditions and health history.

What is the purpose of family history form?

The purpose of a family history form is to gather important information about the health history of an individual's family, which can help in identifying potential genetic risks or predispositions to certain conditions.

What information must be reported on family history form?

Information such as medical conditions, age of onset, and cause of death, if applicable, must be reported on a family history form.