Canada VIHA Paediatric Family History Questionnaire 2018-2026 free printable template
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MEDICAL GENETICS PROGRAM
Medical Genetics Clinic
Telephone 2507274461
Fax 2507274295
Email medicalgenetics@viha.caVictoria General Hospital
1 Hospital Way
Victoria, BC V8Z 6R5Reason for referral:
Referred
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How to fill out Canada VIHA Paediatric Family History Questionnaire
How to fill out Canada VIHA Paediatric Family History Questionnaire
01
Begin by obtaining the Canada VIHA Paediatric Family History Questionnaire from a healthcare provider or the VIHA website.
02
Ensure you have a pen or pencil ready for filling in the details.
03
Start with the child's basic information such as name, date of birth, and health card number at the top of the questionnaire.
04
Proceed to list family members, including parents, siblings, grandparents, aunts, uncles, and any relevant cousins.
05
For each family member, indicate their age, health status, and any known medical conditions.
06
If there are any hereditary conditions present in the family, note those specifically.
07
Complete all sections on the form, even if certain information is unknown; for unknowns, you can mark it as such.
08
After filling out the form, review all entries for accuracy and completeness.
09
Sign and date the questionnaire as required before submitting it to the healthcare provider.
Who needs Canada VIHA Paediatric Family History Questionnaire?
01
Parents or guardians of children who are visiting a healthcare facility for paediatric assessment.
02
Caregivers seeking to provide healthcare providers with comprehensive family health history for better decision-making.
03
Children with known health issues where a detailed family history is necessary to identify potential genetic concerns.
04
Families with a history of hereditary diseases that might impact the child's health.
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What is Canada VIHA Paediatric Family History Questionnaire?
The Canada VIHA Paediatric Family History Questionnaire is a tool used to gather detailed information about the medical backgrounds of a child's family. This information helps healthcare providers assess potential genetic or hereditary health risks.
Who is required to file Canada VIHA Paediatric Family History Questionnaire?
Parents or guardians of children attending health assessments or medical evaluations within the VIHA (Vancouver Island Health Authority) framework are typically required to complete the Paediatric Family History Questionnaire.
How to fill out Canada VIHA Paediatric Family History Questionnaire?
To complete the Canada VIHA Paediatric Family History Questionnaire, individuals should accurately provide information about the health conditions and medical histories of family members, including parents, siblings, and extended family, as instructed on the form.
What is the purpose of Canada VIHA Paediatric Family History Questionnaire?
The purpose of the Canada VIHA Paediatric Family History Questionnaire is to identify any familial health issues that may affect the child’s health and to guide healthcare providers in offering preventive care and tailored medical advice.
What information must be reported on Canada VIHA Paediatric Family History Questionnaire?
The questionnaire requires details about underlying health conditions in family members, including chronic diseases, congenital disorders, mental health issues, and any significant health events that may inform the child's medical care.
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