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Family History Tool

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Information about Family History Collection


Family History Collection Form

pedigree

A family history generally should include:

  • the family structure,
  • medical history of each family member, and
  • environmental history.

Family structure

Identify as many family members as practical, including at least all first-degree relatives (parents, siblings, and children) and second-degree relatives (grandparents, aunts/uncles, and cousins), adding information about more distant relatives as necessary to see patterns in the family.

  • Indicate how individuals are related to each other within the family (for example, whether relatives are maternal or paternal).
  • Identify specific types of relationships, including monozygotic (identical) and dizygotic twins (fraternal), individuals adopted in and out of the family, and step- and half-siblings.
  • Include information about living and deceased relatives.

Medical history and demographic information

The history for each family member should include:

  • Sex
  • Age
  • Any chronic or long-term conditions (or, in a targeted history, the condition[s] of interest)
  • Age at diagnosis
  • Relevant interventions or procedures
  • Cause of death and age at death
  • Ethnicity or country or countries of origin of the family

In situations where risk appears to be significantly increased or when an unusual diagnosis is reported, clinicians should validate diagnoses by reviewing records (e.g., medical records, pathology reports, death certificates).

Lifestyle, diet, and environmental risk factors

Depending on how much the clinician already knows about the patient and his or her history and concerns, the family history may include:

  • important environmental/lifestyle risk factors for disease in relatives, such as smoking, alcohol use, and diet,
  • the patient’s occupation and the occupation of relatives with chronic conditions, and
  • protective environmental/lifestyle modifications, including lifestyle changes, treatments, and surgeries.

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