Genograms Template
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1
2
3
4GENOGRAMS
Gender
Male
Female
Female IP
Male IP
Birthdates & Deathdates
Birth
43-62
Death
Birth
43-63
Death
Pregnancy
Stillbirth
Spontaneous Abortion
Induced Abortion
Marriage Connections
Separation
Divorced
Multiple Marriages
Unmarried Couple Living Together
Birth Order
Foster or Adopted Children
15
13
10
7
3
Oldest
Youngest
Twins
Fraternal
Identical
Family Relationships
Fused & Conflictual
(very close or fused)
Poor or Conflict
Estranged or cut off
Distant
Drug or Alcohol Abuse
Other Information of special importance
1. Ethnic background
7.
Medical conditions – major or chronic
2. Religion or religious change
8.
Mental illness
3. Education
9.
Current locations – major moves
4. Occupation or unemployment
10. Dates left home
5. Trouble with the law
11. Significant others who lived with or
6.
Physical abuse or incest
were important to the family
CWTS
1
CWFT Module 7 Chapter 2
Genograms
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Parent category: Life