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. The doctor can keep it in your file.
Family medical history| Family member | Name | Health problems. (Include approximate age when problem started or occurred.) | If no longer living, cause of death. (Include the age at death.) |
|---|
| My mother | | | |
| My father | | | |
| My sisters and brothers | | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| Mother's mother | | | |
| Mother's father | | | |
| Father's mother | | | |
| Father's father | | | |
| Others | | | |
| | | |
| | | |
© 2017-2025 Healthwise, Incorporated. This information does not replace the advice of a doctor.
