My Family Health Portrait Page 2
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The Surgeon General has launched a national initiative to encourage all
The “My Family Health Portrait” form will
the first line and note “different father” or
help you collect and organize your family
“different mother” on the next line.
American families to learn more about their family health histories.
information. No form can reflect every
Knowing your family’s medical history can save your life.
version of the American family, so use this
Some conditions are more common in
chart as a starting point and adapt it to your
people with a shared background or
With a copy of your family health history, you and a health care professional
family’s needs.
ancestry. It is important to record the
ancestry of your relatives and be as
can individualize your care to prevent and screen for conditions for which
First, write each of your relatives’ names in
specific as possible. For example, if you
you may be at higher risk. Family events, such as Thanksgiving or family
the designated boxes and circle whether
know that your grandmother is Hispanic
reunions, offer a great chance to gather the information for “My Family
they are male (M) or female (F). On the next
and her family comes from Mexico, write
line, write the name of any health conditions
“Mexican” underneath her name. Likewise,
Health Portrait.”
they have had. If you know the age at which
if your family is from Africa, Asia, Europe or
they were diagnosed with a condition, write
South America, note the country they
that in parentheses after the condition. For
came from, if possible.
W
S
I T
W
?
example: “diabetes (diagnosed - age 37).”
HOM
HOULD
ALK
ITH
Once you complete “My Family Health
If family members have died, write
Portrait,” take it to your health care
To get the most accurate health history
Knowing your family health history is a
“deceased” and the age at which they died.
professional so that he or she can better
information, it is important to talk directly
powerful guide to understanding risk for
For example: “heart attack (deceased - age
individualize your health care. Be sure to
with your relatives. Explain to them that
disease. However, keep in mind that a
63).”
make a copy for your records and update it
their health information can help improve
family history of a particular illness may
as circumstances change or you learn
prevention and screening of diseases for all
increase risk, but it almost never
For twins, write “twin” on the first line for
more about your family’s health history.
family members.
guarantees that other family members
both individuals. If the twins are identical,
will develop the illness.
write “identical twin” on the first line for
Congratulations on taking this step toward
Start by asking your relatives about any
both.
a longer, healthier life! “My Family Health
health conditions they have had —
Portrait” can be an effective way to
including history of chronic illnesses, such
Most Important
If your family includes half brothers or half
improve your health — today and in the
as heart disease; pregnancy complications,
sisters, write “half brother” or “half sister” on
future.
such as miscarriage; and any
Parents
developmental disabilities. Get as much
Brothers and Sisters
specific information as possible.
Your Children
It is most useful if you can list the formal
C
UT OUT AND ADD TO CHART AS NEEDED
name of any medical condition that has
Also Important
affected you or your relatives.
Grandparents
M
M
M
You can get help finding information about
F
F
F
Uncles and Aunts
health conditions that have affected you or
Nieces and Nephews
your family members— living or deceased
______________
______________
______________
Half-Brothers and Half-Sisters
— by asking relatives or health care
______________
______________
______________
professionals for information, or by getting
Obtain Information If You Can
______________
______________
______________
copies of medical records.
______________
______________
______________
Cousins
If you are planning to have children, you
______________
______________
______________
and your partner should each create a
Great-Uncles and Great Aunts
family health portrait and show it to your
health care professional.
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