Mercer Island School District
Family Health History AssignmentTracing 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. DIRECTIONSCreate your family tree using the template provided. Please include grandparents, aunts/uncles, parents, cousins, nieces/nephews and yourself. Do not go back more than 2 generations (your 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. Indicate the age of each family (to the best of your ability) underneath their position in your family. If a family member is deceased, indicate the age at which they passed. 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. 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:Indicate any medical issues underneath each family member’s age. Any other special family relations (ie- half siblings, step siblings, etc…) indicate within a parenthesis ( ) underneath their position in your familyColor in the square or circle that indicates where you are in your family tree. 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 RubricRequirementDescription of 100%Points PossiblePoints EarnedCommentsSignature PagePage is completely filled out and signed by a family member and attached to family tree5Medical IssuesMedical 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.10AgesThe approximate ages of all the family members are placed underneath their position in the family. The age of death is placed underneath any deceased family members.3Family PositionThe position of each family member is placed underneath their gender symbol. No specific names appear on the tree only family positions (ie- Aunt, Uncle, Grandma, Grandpa)4KeyA key was created if any special symbols were used on the tree. The student’s shape is filled in. Key is clear, legible, and easy to read. 5Generation LinesEvery family member belonging to the same generation is on the same level on the tree. Lines are straight and neat. Family tree also started with the Grandparent line. 6Country of OriginThe countries of origin are at the very top of the tree; referring to the country where the Grandparent’s family is from. Most likely will not be “The United States” unless the family is Native American. 2TOTAL35 Dear Families,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. 53163216624 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 ................
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