Name Date Section
Creating a Family Health Tree  

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

Name:      Ethnicity:      Date of birth: 

Blood and Rh type:      Occupation: 


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 (manic depressive disorders, 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 above, which 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.

SOURCE: Adapted from March of Dimes Birth Defects Foundation. 1992. Genetic Counseling. Copyright © 1992 March of Dimes Birth Defects Foundation. Used with permission.

Copyright © 2004 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means without the prior written permission of the publisher.