Knowing that a specific disease runs in your family allows you to watch closely for the early warning signs and get appropriate screening tests. It can also help you target important health habits to adopt. You can put together a simple family health tree by compiling key facts on your primary relatives; siblings, parents, aunts and uncles, and grandparents. If possible, have your primary relatives fill out a family health history record like the one below.
| Family Health History | ||
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Name:
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Ethnicity:
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Date of birth:
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Blood and Rh type:
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Occupation:
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Please note any serious or chronic diseases you have experienced, with special attention to the following:
| Alcoholism | |
| Allergies | |
| Arthritis | |
| Asthma | |
| Blood diseases (hemophilia, sickle cell disease, thalassemia, hemochromatosis) | |
| Cancer (breast, bowel, colon, ovarian, skin, and stomach, etc.) | |
| Cystic fibrosis | |
| Diabetes | |
| Epilepsy | |
| Familial high blood cholesterol levels | |
| Hearing defects | |
| Heart defects | |
| Huntington’s disease | |
| Hypertension (high blood pressure) | |
| Learning disabilities (dyslexia, attention-deficit/hyperactivity disorder, autism) | |
| Liver disease (particularly hepatitis) | |
| Lupus | |
| Mental illness (depression, bipolar disorder, schizophrenia) |
| Mental impairment (Down syndrome, fragile X, etc.) | |
| Migraine headaches | |
| Miscarriages or neonatal deaths | |
| Multiple sclerosis | |
| Muscular dystrophy | |
| Myasthenia gravis | |
| Obesity | |
| Phenylketonuria (PKU) | |
| Respiratory disease (emphysema, bacterial pneumonia) | |
| Rh disease | |
| Skin disorders (particularly psoriasis) | |
| Thyroid disorders | |
| Tay-Sachs disease | |
| Tuberculosis | |
| Visual disorders (dyslexia, glaucoma, retinitis pigmentosa) | |
| Other (please list): |
List any important health-related behaviors (including tobacco use, dietary and exercise habits, and alcohol use):
Please note names of your relatives below, along with indications of any illnesses, such as those listed on the previous page, that affected them. If they are deceased, list age and cause. Also make note of their lifestyle habits such as smoking.
Father:
Mother:
Brothers and sisters:
Children of brothers and sisters:
If you don’t have enough information on past generations, you can get clues by requesting death certificates from state health departments or medical records from relatives’ physicians or hospitals where they died. Once you’ve collected the information you want, plug it into a tree format. An online version of a family health tree is available at http://www.generationalhealth.com.