Family Health History Assignment
Tracing the illnesses suffered by your parents, grandparents, blood relatives, and even non-blood relatives can help your doctor predict the disorders to
which you may be at risk and take action to keep you healthy. Health care professionals have known for a long time that diseases; heart disease, cancer,
diabetes, hemophilia, cystic fibrosis, and sickle cell anemia can run in families. If one generation of a family has high blood pressure, it is not unusual for the next
generation to have similarly high blood pressure. "The bottom line is that knowing your family history can save your life," said U.S. Surgeon General Richard H.
Carmona.
DIRECTIONS
1) Create the family tree with all of your relatives listed on the family tree. Please include grandparents, aunts/uncles, parents, cousins, nieces/nephews
and yourself. Do not go back more than 3 generations (your great grandparents). See the key on the next page to know how to indicate specific family
members and their genders. Everyone in the same generation should be at the same level.
2) Indicate the age of each family (to the best of your ability) underneath their position in your family.
3) At the top of each side (mother and fathers) write your family’s heritage; meaning what countries that part of your family came from. This information
is important because some genetic health problems occur more often in specific ethnic groups.
4) Ask your family members and as far back as possible about your family history as it relates to the following or more(you are not limited to this list)
medical issues:
5) Indicate any medical issues underneath each family member’s age.
6) Any other special family relations (ie- half siblings, step siblings, etc…) indicate within a parenthesis ( ) underneath their position in your family
7) Color in the square or circle that indicates where you are in your family tree.
8) If you are adopted, you can choose to do this assignment based on the family you know or can find out the most about. Even if you are not biologically
related to the family you live with now, you could still be environmentally prone to some medical issues.
Name: ________________________________________________
Date: _______________________
Period: _______
Family Health History Assignment Rubric
Requirement
Description of 100%
Points
Possible
Signature Page
Page is completely filled out and signed by a family
member and attached to family tree
Medical issues that are genetic, non-genetic, and
environmental are placed accordingly to the family tree.
This is including any medical issues that the student
themselves might have
The ages of all the family members are placed underneath
their position in the family. The age death is placed
underneath any deceased family members
The position of each family member is placed underneath
their gender symbol. No specific names appear on the tree
just family positions (ie- Aunt, Uncle, Grandma, Great
Grandpa)
A key was created if any special symbols were used on the
tree. Key is clear and easy to read
Every family member belonging to the same generation is
on the same line on the tree. Lines are straight and neat.
The countries of origin are at the very top of the tree
describing where each of the great- grandparents are from
5
Medical Issues
Ages
Family Position
Key
Generation Lines
Country of Origin
TOTAL
Dear Families,
10
3
2
5
5
5
35
Points
Earned
Comments
Your Image student has been tasked with the job of finding out his/her family health history. It is extremely important to know what you could be
genetically or environmentally at risk for. Knowing ahead of time could possibly save your life with the right precautionary steps.
Your student is of course not required to write down ALL of the medical issues that members of your family might have experienced. Family medical
history can be a very private matter, so if there is anything you would not like your student to share that is completely up to your jurisdiction. Your student might
want to still be aware of the medical issue but it does not need to appear on their assignment. They will not be sharing the assignment with any other
classmates. Only I will be seeing it to grade it.
If you could please check mark next to the statement below, stating that your student interviewed at least one person in your family that would be very
much appreciated. Contact with family members certainly does not have to be in-person. Phone calls or other means of electronic communication are welcomed
as well.
I have discussed our family health history with _____________________________________________ (Image student’s name) and now she/he has a
better understanding of which medical conditions have a genetic and/or environmental history in our family.
_____________________________________________________
Family Member Signature
_____________________________________________________
Printed Family Member Name