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Primary Research Institute 665 Stockton Dr. STE 200 I Eaton, PA 19341 Tel: 6104581112 Fax: 6104581114Hereditary Cancer History Form Name: Date of Birth: Date Completed: Race: Gender: M or F Phone:

How to fill out hereditary cancer history form

How to fill out hereditary cancer history form

1. To fill out the hereditary cancer history form, follow these steps:
2. Start by providing your personal information, such as your name, date of birth, and contact details.
3. Move on to the family history section, where you will be asked to provide details about your immediate family members (parents and siblings) and their cancer history.
4. If any of your immediate family members have been diagnosed with cancer, provide their names, types of cancer, age at diagnosis, and any additional relevant information.
5. Proceed to fill out the extended family history section, where you can provide information about other relatives who have had cancer.
6. If you are aware of any genetic testing done within your family, indicate it in the appropriate section along with the results, if available.
7. Finally, review the completed form to ensure all information is accurate and complete.
8. Sign and date the form to confirm its authenticity.

Who needs hereditary cancer history form?

1. The hereditary cancer history form is important for individuals who want to assess their own risk of developing hereditary cancers or those who have a family history of cancer.
2. It is particularly relevant for individuals who may be considering genetic testing or those who are seeking guidance on cancer prevention and early detection strategies based on their family history.
3. Healthcare providers, genetic counselors, and oncologists also use the hereditary cancer history form to evaluate the risk of hereditary cancer in their patients and guide personalized care decisions.

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What is hereditary cancer history form?

A hereditary cancer history form is a document used to collect information about an individual's family history of cancer, particularly hereditary cancers, to assess genetic risk.

Who is required to file hereditary cancer history form?

Individuals with a family history of cancer, particularly those with known hereditary cancer syndromes, are typically required to file this form, often as part of genetic counseling or testing.

How to fill out hereditary cancer history form?

To fill out the hereditary cancer history form, individuals should provide detailed information about their family members, including names, relationships, ages at diagnosis, types of cancer, and any genetic test results.

What is the purpose of hereditary cancer history form?

The purpose of the hereditary cancer history form is to identify individuals at higher risk of hereditary cancers, facilitate genetic counseling, and guide decisions regarding screening and prevention strategies.

What information must be reported on hereditary cancer history form?

The form requires information about the individual's personal cancer history, family members' cancer diagnoses, ages of diagnosis, types of cancer, and any known hereditary cancer syndromes in the family.