Your Family Medical History
Overview
Health problems sometimes run in the family. That's why it's important to know as much as you can about the health problems of your birth family. This information can help your doctor provide better care.
Start with what you know. Then ask your parents or other relatives for more information. It's a good idea to update this chart every year or so. Take a copy with you every time you see a new doctor. He or she can keep it in your file.
Family medical historyFamily member | Name | Health problems. (Include approximate age when problem started or occurred.) | If no longer living, cause of death. (Include the age at death.) |
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My mother |
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My father | | | |
My sisters and brothers |
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Mother's mother | | | |
Mother's father | | | |
Father's mother | | | |
Father's father | | | |
Others |
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Credits
Current as of: November 15, 2023
Current as of: November 15, 2023
