Family Personal History Assessment indd 2025

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  1. Click ‘Get Form’ to open the Family Personal History Assessment in the editor.
  2. Begin by entering your name in the designated field at the top of the form. This personalizes your assessment and ensures accurate record-keeping.
  3. In the 'Type of Cancer' section, check all applicable cancer types that you or your family members have experienced. Be sure to include age at diagnosis for yourself and first-degree relatives.
  4. For second and third-degree relatives, provide similar information on both your mother's and father's sides. Use estimates if exact ages are unknown.
  5. If applicable, indicate if your family is of Ashkenazi Jewish descent and provide details about any previous genetic testing results in the space provided.
  6. Review all entries for accuracy before saving or submitting your completed form through our platform.

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Types of information to be included in family history Age for all relatives (age at time of death for the deceased) Ethnicity (some genetic diseases are more common in certain ethnic groups) Presence of chronic diseases.
A properly collected family history can: Identify whether a patient has a higher risk for a disease. Help the health care practitioner recommend treatments or other options to reduce a patients risk of disease. Provide early warning signs of disease.
In addition to detecting increased risk for mendelian conditions, the family history can also indicate genetic risk factors for common adult diseases, particularly for specific cancers, including , ovarian, and colorectal cancer.

People also ask

Family history is considered one of the most important risk factors for health problems such as heart disease, stroke, diabetes, cancer and certain psychiatric disorders.
Age at diagnosis can give important clues to understanding certain conditions. Your familys health history information helps health care providers identify if your family has a pattern of early-onset conditions, which could mean youre at a higher risk.
If you have a close family member with a chronic disease, you may be more likely to develop that disease yourself, especially if more than one close relative has (or had) the disease or a family member got the disease at a younger age than usual.
Ask questions like: How old are you? Do you or did anyone in our family have any long-term health problems, like heart disease, diabetes, kidney disease, bleeding disorder, or lung disease? Do you or did anyone in our family have any health issues like high blood pressure, high cholesterol, or asthma?

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