Guidelines for Family Genetic History Assignment PURPOSE This assignment is to help you gain insight regarding the influence of genetics on an individual?s health and risk for disease. You are to obtain a family genetic history on a willing, non-related, Custom Essay

Family Genetic History Form
Your Name: Date:
Your Instructor?s Name:
Purpose: This assignment is to help you gain insight regarding the influence of genetics on an individual?s health and risk for disease. You are to obtain a family genetic history on a willing, non-related, adult

participant.
Disclaimer: When taking a family genetic history on an actual client, it is essential that the information is accurate. Please inform the person you are interviewing that they do NOT need to disclose information

that they wish to keep confidential. If the adult participant decides not to share information, please write, ?Does not want to disclose.?
Directions: Refer to the Family Genetic History guidelines and grading rubric found in Doc Sharing to complete the information below. This assignment is worth 100 points.
Type your answers on this form. Click ?Save as? and save the file with the assignment name and your last name, e.g., ?NR305_Family_Genetic_History_Form_Smith? When you are finished, submit the form

to the Family Genetic History Dropbox by the deadline indicated in your guidelines. Post questions in the Q&A Forum or contact your instructor if you have questions about this assignment.
1: Family Genetic History (35 points):
Develop a family genetic history that includes, at a minimum, three generations of your chosen adult?s family including grandparents, parents, and the adult?s generation. If the adult has any children, include

them as the fourth generation. **PLEASE NOTE: This assignment is to reveal the potential impact of the family?s health on the adult participant. You do not need to identify anyone who is not biologically

related to the adult except for a spouse/significant other.
You do not need to use symbols but instead write brief descriptions for each person. Each description should include the following information: first name, birthdate, death date, occupation, education, primary

language, and a health summary including any medical diagnoses. An example is below:
Family Member Description
Paternal grandfather
First and last initials: RL
Birthdate: 1921
Death date: 1981
Occupation: Retired as a coal miner
Education: 6th grade
Primary language: English
Health summary: He was diagnosed with chronic lung disease, diabetes, and hypertension. He died from a heart attack.
Paternal grandmother
First and last initials: ML
Birthdate: 1932
Death date: 1998
Occupation: House wife
Education: Does not want to disclose
Primary language: English
Health summary: Diagnosed with chronic lung disease from smoking cigarettes. Died from heart failure.
This example points to common problems among this generation on both sides of the family. Consider the implications this would have for the adult participant?s health if these were that person?s family

members.
Complete the family genetic history form below. Indicate if any information is N/A (not applicable) or unknown. Indicate any information the person did not want to disclose by noting ?Does not want to

disclose.?
Family Member Description
Paternal grandfather
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Paternal grandmother
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Father
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Father?s siblings (write a brief summary of any significant health issues)
Maternal grandfather
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Maternal grandmother
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Mother
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Mother?s siblings (write a brief summary of any significant health issues)
Adult Participant
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Adult participant?s siblings (write a brief summary of any significant health issues)
Adult participant?s spouse/significant other
First and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Adult participant?s children (write a summary for each child, up to four children)
Child #1 first and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Child #2 first and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Child #3 first and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Child #4 first and last initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:

2. Evaluation of family genetic history (25 points)
Evaluate the impact of the family?s genetic history on your adult participant?s health. For example, if the adult participant?s mother and both sisters have diabetes, hypertension, or cancer, what might that mean

for the adult participant?s future health?

3. Planning for future wellness (35 points)
Plan changes based on the evaluation of the adult participant?s family?s health history that will promote an optimal level of wellness both now and in the future. Include what information you would provide to

the adult participant regarding the results of the family genetic history.

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