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FAMILY HEALTH HISTORY Patient's Name Date Because subluxations tend to run in families & in people who do similar activities, this form will help us better understand your case. For the diseases/conditions
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How to fill out your family health history

01
Gather information about your immediate family members (parents, siblings, and children) and extended family members (grandparents, aunts, uncles, and cousins).
02
Ask about any medical conditions, illnesses, or diseases that each family member has been diagnosed with.
03
Record the name of the condition, the age at diagnosis, and any additional relevant information such as treatment or surgeries.
04
Include both physical and mental health conditions, as well as any genetic disorders.
05
Use a family health history form or create a document to organize the information.
06
Keep the document up to date by adding new information as it becomes available.
07
Share the family health history with your healthcare provider during check-ups and when discussing preventive screenings or genetic testing.

Who needs your family health history?

01
Anyone who wants to assess their risk for certain medical conditions and diseases.
02
Healthcare providers can use family health history to evaluate a patient's risk, recommend preventive measures, and provide targeted screenings or treatment.
03
Individuals planning to start a family may need their family health history to understand the risk of passing on genetic disorders to their children.
04
Researchers and scientists studying genetic links to diseases can benefit from family health history data to identify patterns and potential genetic markers.
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Family health history includes information about diseases or medical conditions that run in the family.
Individuals are required to fill out their family health history form, typically for medical or research purposes.
You can fill out your family health history form by providing information about your relatives, their medical conditions, and any hereditary diseases.
The purpose of family health history is to identify any patterns of diseases or medical conditions that may be hereditary and to help healthcare providers make more informed decisions about your health.
Information such as the medical conditions, diseases, and age at diagnosis of your relatives should be reported on your family health history.
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