Family History

Under Family History, outline or diagram the age and health, or age and cause of death, of each immediate relative, including parents, grandparents, sib lings, children, and grandchildren. Review each of the following conditions and record if they are present or absent in the family: hypertension, coronary artery disease, elevated cholesterol levels, stroke, diabetes, thyroid or renal disease, cancer (specify type), arthritis, tuberculosis, asthma or lung disease, headache, seizure disorder, mental illness, suicide, alcohol or drug addiction, and allergies, as well as symptoms reported by the patient.

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