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Family History Questionnaire for Common Hereditary Cancer Syndromes Patient Name: Date of Birth: Age: Have you had genetic testing for a hereditary cancer syndrome? Yes/ No If YES, who performed the

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How to fill out personalfamily history questionnaire for

Point by point instructions on how to fill out a personalfamily history questionnaire:

01

Begin by carefully reading through the questionnaire to familiarize yourself with the sections and questions it contains.

02

Gather all necessary information before starting. This may include information about your immediate family members (parents, siblings, and children), as well as extended family members (grandparents, aunts, uncles, and cousins).

03

Start by filling out your own personal information, including your full name, date of birth, and contact details.

04

Move on to the section on immediate family members. Provide details about your parents, such as their full names, dates of birth, and any relevant medical history or conditions they may have.

05

If applicable, provide information about your siblings, including their names, dates of birth, and any known medical history or conditions.

06

Proceed to the section on your own medical history. Answer the questions honestly and provide accurate information about any past or current medical conditions, surgeries, or treatments you have undergone.

07

Provide information about any chronic conditions or illnesses that run in your family. This can include heart disease, diabetes, cancer, and mental health conditions, among others.

08

If prompted, provide information about your grandparents and their medical histories to the best of your knowledge.

09

Finally, review your answers to ensure accuracy and completion before submitting the questionnaire.

Who needs a personalfamily history questionnaire?

A personalfamily history questionnaire is beneficial for individuals and families who wish to gain a comprehensive understanding of their genetic predispositions, hereditary diseases, and common health conditions within their family. It is particularly useful for individuals seeking to make informed decisions about their health, as well as medical professionals who may need to take a thorough family history into account when providing care or making diagnoses. Additionally, individuals who want to participate in clinical research studies or genetic testing may be required to fill out a personalfamily history questionnaire.

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What is personalfamily history questionnaire for?

The personal/family history questionnaire is used to gather information about an individual's medical history as well as the medical history of their family members.

Who is required to file personalfamily history questionnaire for?

Individuals who are seeking medical treatment or care may be required to fill out a personal/family history questionnaire by their healthcare provider.

How to fill out personalfamily history questionnaire for?

To fill out a personal/family history questionnaire, individuals should provide accurate and detailed information about their own medical history and the medical history of their family members.

What is the purpose of personalfamily history questionnaire for?

The purpose of the personal/family history questionnaire is to help healthcare providers assess a patient's risk for certain medical conditions based on their genetic predisposition and family history.

What information must be reported on personalfamily history questionnaire for?

Information that should be reported on a personal/family history questionnaire includes details about any medical conditions, diseases, or disorders that the individual or their family members have experienced.

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