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First, Last Name DOB: Family Medical History Questionnaire (FMH) Cord Blood Bank Use Only:MDP CBU ID: Local CBU ID: MDP Maternal ID: Local Maternal ID: Today's Date: Baby's Mother's Initials: Please
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How to fill out family medical history questionnaire

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How to fill out family medical history questionnaire

01
Begin by gathering information about your immediate family members, including parents, siblings, and children.
02
Make note of any medical conditions that have been diagnosed in your family members, such as heart disease, diabetes, cancer, and high blood pressure.
03
Include any information about surgeries or hospitalizations that your family members have undergone.
04
Take note of any medications that your family members are currently taking.
05
Fill out the family medical history questionnaire form, providing detailed information about each family member and their medical history.
06
Be as accurate and specific as possible when filling out the questionnaire, including dates of diagnoses, treatments, and outcomes.
07
If you are unsure about any information, try to gather additional details from family members or consult medical records.
08
Submit the completed family medical history questionnaire to the relevant healthcare provider or organization.

Who needs family medical history questionnaire?

01
Anyone who is seeking healthcare services or undergoing medical examinations can benefit from filling out a family medical history questionnaire.
02
Medical professionals, including doctors, nurses, and genetic counselors, may request patients to fill out the questionnaire to better understand their risk factors and make informed healthcare decisions.
03
Individuals who have a family history of certain medical conditions, such as hereditary diseases or conditions with a genetic component, may be specifically recommended to fill out the questionnaire.
04
It can be especially important for individuals planning to start a family or those involved in reproductive health to provide a comprehensive family medical history.
05
Insurance companies or research organizations may also ask individuals to fill out the questionnaire for assessing risks or conducting studies.
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The family medical history questionnaire is a tool used to gather information about the health conditions and diseases that may run in a person's family.
Individuals who are asked by their healthcare provider to provide information about their family's medical history.
To fill out the family medical history questionnaire, one must provide information about their relatives' health conditions and diseases.
The purpose of the family medical history questionnaire is to assess an individual's risk of developing certain health conditions based on their family's history.
Information such as specific health conditions, age of onset, and any relevant details about family members' medical history must be reported on the family medical history questionnaire.
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