Get the free Family history intake form for Breast Cancer

REFERRAL FOR BREAST CANCER GENETIC TESTING Fax to 01223 281316 or email to Referral GeneHealthUK.com Referral to: (name of genetic counselor if known)Patient details: Name: DOB: Address: Phone number:

How to fill out family history intake form

How to fill out family history intake form

1. Start by gathering all necessary information about your family's medical history.
2. Carefully read through the family history intake form to understand what information is required.
3. Fill out the form accurately, providing details about any hereditary medical conditions, past illnesses, and causes of death within your immediate and extended family.
4. Include information about your parents, siblings, grandparents, aunts, uncles, and cousins.
5. Specify the medical conditions, dates of diagnoses, treatments, and outcomes for each family member.
6. If you're unsure about certain aspects of your family's medical history, reach out to relatives or consult any available medical documents to gather accurate information.
7. Avoid making assumptions or guessing the details; provide only verified facts.
8. Double-check your completed form for any errors or missing information before submitting it.
9. Submit the filled-out family history intake form to the appropriate healthcare provider.

Who needs family history intake form?

1. Anyone seeking medical care or undergoing genetic testing may need to fill out a family history intake form.
2. Medical professionals, genetic counselors, and healthcare institutions utilize these forms to assess an individual's risk of developing certain hereditary medical conditions based on their family's medical history.
3. Individuals with a family history of significant medical conditions, genetic disorders, or those who have lost family members to certain diseases may particularly be required to fill out this form as part of their medical evaluation process.

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What is family history intake form?

Family history intake form is a document that collects information about an individual's family medical history, including any hereditary conditions or diseases that run in the family.

Who is required to file family history intake form?

Anyone seeking medical care or participating in a research study may be required to fill out a family history intake form.

How to fill out family history intake form?

To fill out a family history intake form, one must provide detailed information about their family members' medical history, including any known diseases, conditions, or health concerns.

What is the purpose of family history intake form?

The purpose of a family history intake form is to help healthcare providers assess an individual's risk for certain diseases or conditions based on their genetic predisposition.

What information must be reported on family history intake form?

Information such as the medical history of immediate family members (parents, siblings, children), any known genetic conditions, and instances of certain diseases in the family must be reported on a family history intake form.