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A Gift of Medical Knowledge to Future Generations — Your Family TreeYour family tree can become a gift of medical knowledge to future generations. An accurate medical family history may help you and your family identify potential health concerns and risks. This information can contribute to better preventive care. Huntsman Cancer Institute has developed a short medical family history form that will help determine whether your family would benefit from an appointment with the Family Cancer Assessment Clinic (FCAC). The FCAC is a medical and genetic consultation resource for individuals and families who are concerned about the role genetics may play in the cancers in their family. This information will only be used to determine your appropriateness for an FCAC appointment and not for any specific risk assessment or medical advice.
CLICK HERE for the Family Medical History Questionnaire You are welcome to print this form for your own use. If you fill it out electronically and hit the "Submit Questionnaire" button, the information will be transmitted through a secure network to the FCAC. Your information will not be available to, or shared with, anyone other than FCAC staff. After the information has been reviewed, a specialist from the FCAC will contact you. If you have additional questions about completing the form or about the FCAC, please call (801) 587-9555. To learn more about developing your own medical family history, please visit
the U.S. Surgeon General's web site at:
http://www.hhs.gov/familyhistory/ or the National Society of Genetic Counselors
web site at:
http://www.nsgc.org/consumer/familytree/index.asp.
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