Family Health History Form
What is a family health history form?
A family health history form is a record of a patient and his/her close relative’s health information. It could include information about up to 3 generations of the patient’s family. It is used to track medical diseases that run in the family. Health information of children, brothers and sisters, parents, aunts and uncles, nieces and nephews, grandparents, and cousins may be included in the family health history form.
Why is a family health history form needed?
The details in the family health history form will help track any diseases that run in the family. A patient could have a predisposition to a certain disease if it runs in the family. Therefore having a record of the same will help the medical practitioner make an informed decision about a patient’s disease diagnosis and/or treatment. In summary, the family health history form allows to :
- Identify any health risks
- Guide medical decisions
- Helps tailor prevention, screening, and treatment strategies
For example, if a significant number of a patient’s family members have a history of heart disease, the patient may also be prone to heart disease.
Who fills the family health history form?
The form is filled out by the patient themselves. The patient has all the information pertaining to their family and therefore is the best person to fill out the form.
What information is filled in the form?
The patient has to fill in the details about the diseases that run in the family. Details of the diseases of the close relatives of the patient need to be filled in the form. Along with the disease name, the patient should also fill in the age at which a certain family member came to have that particular disease. To summarize, the information would be:
- Names and ages of family members
- Relationships between family members (e.g., parent, sibling, grandparent)
- Medical conditions that run in the family
- Age at which family members were diagnosed with certain conditions