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OMB Control # 10760160 Expiration Date:10/31/2024Family History Chart For Categories B, C & D (IV) Great grandfather BD:___ (III) GrandfatherTribe:BD:___ (IV) Great grandmother Tribe:BD:___ Tribe:(II)
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How to fill out family history chart

01
Begin by gathering as much information as possible about your family members, including names, dates of birth, and any medical conditions they may have had.
02
Use a family history chart template to organize this information in a clear and structured manner.
03
Fill in the chart with the relevant details for each family member, including any known genetic conditions or diseases that are common in your family.
04
Be sure to include information about any deceased family members as well, as this can also be important for understanding your genetic risk factors.
05
Update the family history chart regularly as new information becomes available, such as through conversations with relatives or additional medical testing.

Who needs family history chart?

01
Anyone who is interested in understanding their genetic risk factors for certain medical conditions
02
Healthcare professionals who are providing care for a patient and need a comprehensive understanding of their family medical history
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A family history chart is a visual representation of an individual's family tree and medical history.
Family history charts are typically prepared and filed by individuals or families to document their ancestry and health information.
Family history charts can be filled out manually by hand or using online tools and software that allow for easy input and organization of information.
The purpose of a family history chart is to provide a comprehensive overview of an individual's genetic and health background, which can be useful for medical professionals in assessing health risks and making treatment decisions.
Family history charts should include information such as names, dates of birth and death, medical conditions, and any other relevant health information for multiple generations.
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