Get the free Hereditary Cancer Risk Assessment Program Referral Form. Hereditary Cancer Risk Asse...

Hereditary Cancer Risk Assessment Program Fax Referral To: (513) 8031111 Schedule by phone: (513) 6364760 (option 1) Today's Date: Patient Name: DOB: Best Contact Number: Date Referring Physician:

How to fill out hereditary cancer risk assessment

How to fill out hereditary cancer risk assessment

1. To fill out the hereditary cancer risk assessment, follow these steps:
2. Start by providing your personal and contact information, such as name, age, gender, and address.
3. Answer questions about your family history of cancer. Include information about close relatives like parents, siblings, and children.
4. Fill in details about the types of cancer that your relatives have been diagnosed with and their age at diagnosis.
5. Indicate if any family member has previously undergone genetic testing and share the results if available.
6. Answer questions about your own medical history, including any personal history of cancer or other conditions.
7. Provide information on lifestyle factors that may influence cancer risk, such as smoking habits, diet, and exercise.
8. Review your answers for accuracy and make any necessary corrections.
9. Once you have completed the form, submit it to the designated healthcare professional or institution.

Who needs hereditary cancer risk assessment?

1. Hereditary cancer risk assessment is recommended for individuals who:
2. - Have a significant family history of cancer, particularly if multiple family members have been affected.
3. - Have personal or family history of certain types of cancer known to have a hereditary component.
4. - Want to understand their inherited risk of developing cancer and make informed decisions about screening and prevention.
5. - Have been diagnosed with cancer at a young age or have had multiple primary cancers.
6. - Are considering genetic testing or counseling related to cancer risk.

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What is hereditary cancer risk assessment?

Hereditary cancer risk assessment is a medical evaluation that identifies individuals at risk of developing hereditary cancer based on their family history and genetic factors.

Who is required to file hereditary cancer risk assessment?

Individuals with a family history of cancer or those who have genetic mutations that increase their risk of cancer may be required to file hereditary cancer risk assessment.

How to fill out hereditary cancer risk assessment?

Hereditary cancer risk assessment can be filled out by providing information about personal and family medical history, as well as genetic testing results if available.

What is the purpose of hereditary cancer risk assessment?

The purpose of hereditary cancer risk assessment is to identify individuals who may benefit from increased screening, prevention strategies, or genetic counseling based on their elevated risk of cancer.

What information must be reported on hereditary cancer risk assessment?

Information such as personal medical history, family history of cancer, genetic testing results, and any previous cancer diagnoses should be reported on hereditary cancer risk assessment.