QUESTION
Family Genetic History Form
YourName: Date:
Your Instructorâs Name:
Purpose: This assignment is to help you gain insight
regarding the influence of genetics on an individualâs health and risk for
disease. You are to obtain a family genetic history on a willing, nonrelated,
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, âDoes not want to disclose.â
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 âSave asâ and save the file with the assignment name and your last
name, e.g., âNR305_Family_Genetic_History_Form_Smithâ.When you are finished,
submit theform to theFamily 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 adultâs family, including grandparents, parents, and
the adultâs 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 familyâs health on the adult participant. You do not need to
identify anyone who is not biologically related to the adult except for a
spouse or 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
participantâshealth if these were that personâs 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 âDoes not want to
disclose.â
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:
Fatherâs 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:
Motherâs 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
participantâs siblings (write a brief summary of any significant health
issues)
Adult
participantâs spouse/significant other
First and last
initials:
Birthdate:
Death date:
Occupation:
Education:
Primary language:
Health summary:
Adult
participantâs 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 thefamilyâs genetic history on your adult
participantâs health. For example, if the adult participantâs mother and both
sisters have diabetes, hypertension, or cancer, what might that mean for the
adult participantâs future health?
3.
Planning for future wellness (35 points)
Plan changes based on the evaluation of the adult participantâsfamilyâs
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.
ANSWER:
Place an order in 3 easy steps. Takes less than 5 mins.