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May 15, 2024 · My Family Health Portrait A free, online family health history collection tool that lets you share family health history information with relatives and assess your risk for certain conditions.
May 15, 2024 · Knowing and acting on your family health history can be an important part of staying healthy. Family health history can help your healthcare provider decide what screening tests and other interventions you need and when.
A family history (PDF) is a lifetime record that patients should provide to all their new physicians when receiving health care. The history should be detailed, including: First-, 2nd- and 3rd-degree relatives.
A family history is one of the most powerful “genetic tests” to identify if families are at increased risk for chronic diseases and certain cancers. Discovering this early can often improve, delay or prevent negative health outcomes.
Adult Family History Form. Date ______________ Please complete as much of this form as possible and RETURN it before your next appointment. This information may be useful to your doctor prior to your appointment.
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Family History: Please list any known medical problems for the relatives listed below: For example: diabetes, breast/colon/ovarian/ prostate cancer, heart attacks, high blood pressure, alcohol abuse, depression, skin cancer, osteoporosis.
This form does not replace the health history form that you fill out at your health care provider’s office. But you can use it to get started on your family health history. Share the form with your provider — it gives helpful information about health conditions that run in your family.
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