Table 3.
Document complexity of fill-in family history forms
| Fill-in family history forms | Available in Spanish | Disease focus | Document complexity level |
|---|---|---|---|
| ADHD Support: | |||
| Apples on the Family Tree (Family Tree) | No | ADHD | Level 2 proficiency – low complexity |
| American Heart Association: | |||
| Go Red for Women Family Tree | Yes | Heart disease | Level 2 proficiency – low complexity |
| American Heart Association: | |||
| The Heart of Diabetes | No | Diabetes | Level 2 proficiency – low complexity |
| American Heart Association – Wisconsin Stroke Committee | |||
| Reproducible Family Health History Tree | No | Stroke and high blood pressure | Level 2 proficiency – low complexity |
| American Medical Association: | |||
| Adult Family History Form | No | Multiple | Level 3 proficiency – moderate complexity |
| Aurora Health Care: | |||
| Hereditary Cancer Risk Assessment Tool | No | Cancer | Level 2 proficiency – low complexity |
| Centre for Genetics Education of the NSW Genetics Service | |||
| Family Health History Can Matter (My Family Health Record) | No | Multiple | Level 1 proficiency – very low complexity |
| Genetic Alliance: | |||
| Family Health History Questionnaire | No | Multiple | Level 2 proficiency – low complexity |
| Genetics in Primary Care (GPC) project, Family History Working Group: | |||
| Genetic Tools Family Disease Checklist | No | Multiple | Level 4 proficiency – high complexity |
| Genetics in Primary Care (GPC) project, Family History Working Group: | |||
| Your Family Medical History | No | Multiple | Level 3 proficiency – moderate complexity |
| Howard University – National Human Genome Center: | |||
| Planning for a Healthy Future: The Importance of Family Health History (Family Health History Tree) | No | Multiple | Level 3 proficiency – moderate complexity |
| Indiana University School of Medicine Department of Medical Genetics | |||
| Family History Questionnaire | No | Multiple | Level 4 proficiency – high complexity |
| Lahey Clinic Foundation Familial Cancer Risk Assessment Center: | |||
| Cancer Risk Evaluation Packet | No | Cancer | Level 4 proficiency – high complexity |
| March of Dimes: | |||
| Family Health Questionnaire (Prenatal) | Yes | Prenatal syndromes | Level 4 proficiency – high complexity |
| Michigan Department of Community Health: | |||
| Family History and High Blood Pressure | No | Blood pressure | Level 2 proficiency – low complexity |
| National Breast Cancer Centre: | |||
| Family History Questionnaire | No | Breast cancer | Level 2 proficiency – low complexity |
| National Coalition for Health Professional Education in Genetics: | |||
| Family History Questionnaire | No | Multiple | Level 4 proficiency – high complexity |
| New York State Department of Health: | |||
| Sample Cancer Family History Questionnaire | No | Cancer | Level 2 proficiency – low complexity |
| Prevent Cancer Foundation: | |||
| Guide to Preventable Cancer (Family Medical History Chart) | No | Cancer | Level 2 proficiency – low complexity |
| Princess Margaret Hospital: | |||
| Family History Questionnaire | No | Cancer | Level 4 proficiency – high complexity |
| U.S. Surgeon General's Family History Tool: | |||
| My Family Health Portrait (paper version) | Yes | Multiple | Level 3 proficiency – moderate complexity |
| University of Bristol: | |||
| The Questionnaire | No | Colorectal cancer | Level 1 proficiency – very low complexity |
| University of Chicago: | |||
| Cardiology Family History Questionnaire | No | Cardiovascular disease | Level 4 proficiency – high complexity |
| University of Virginia Health Systems: | |||
| Are You at Risk for Hereditary Breast Cancer? | No | Breast and ovarian cancer | Level 2 proficiency – low complexity |
| Utah Department of Health: | |||
| Health Family Tree Tool | Yes | Multiple | Level 2 proficiency – low complexity |
Note: Grade level equivalent range for proficiency levels. Level 1: grade 4 equivalent to less than 8 years of schooling; Level 2: grade 8 equivalent to high school diploma; Level 3: grade 12 equivalent to some education after high school; Level 4:15 years of schooling to college degree equivalent; Level 5: 16 years of schooling to more advanced postgraduate degree.