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Medical Conditions in Your Family (Parents, grandparents, brothers, sisters, aunts, uncles)

Video

Condition

Relative

Age of Onset

Age & Cause of Death

Medical Log

Condition/Surgery

Date Diagnosed

Doctor/Treatment/Comments

Blood Type:

You're pretty good with maintaining a healthy lifestyle, but how important is your family's health? Source: healthcare411.ahrq.gov

Cataracts/Glaucoma

Alcohol/Drug Abuse

Cancer & Type

Arthritis

Allergies/Asthma

Bowel Disorder (Crohn’s Disease, Colitis)

Hearing Problems

Depression

Diabetes

Migraine Headaches

Heart Disease/Stroke

Smoker

High Blood Pressure

Pneumonia

Thyroid Problems

Thrombosis (Blood Clots)

Drug Sensitivities:

Allergies: