Get Uc Davis Pre-visit Family History Form
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How to fill out the UC Davis Pre-Visit Family History Form online
Completing the UC Davis Pre-Visit Family History Form is an important step in preparing for your visit to the Hereditary Cancer Program. This guide will help you navigate the form online, ensuring that you provide all necessary information accurately.
Follow the steps to complete the form effectively
- Click the ‘Get Form’ button to obtain the form and open it on your device.
- Begin by entering your name and appointment details at the top of the form to ensure that your information is correctly associated with your visit.
- Fill in your ancestry or ethnicity in the designated area, providing as much information as you can regarding your background.
- Move on to the section labeled 'Father's Family' and 'Mother's Family.' Here, you will input details about your family members, including grandparents, parents, and aunts/uncles. Record their current age or age at death, type of cancer (if applicable), and age at diagnosis.
- In the section for 'Your Cousins,' categorize them into two groups: those with cancer and those without. Make sure to provide current age or age at death, cancer type, and age at diagnosis for those with cancer. For those without, indicate the total number and gender breakdown.
- Continue with 'Your Nieces/Nephews' and 'Your Children.' Collect and enter information similarly, ensuring accurate data for both cancer status and age.
- Address the additional questions towards the end of the form, answering yes or no to each. This includes inquiries about Ashkenazi Jewish ancestry and familial relationship structures.
- Include any additional notes that may be pertinent to your family's medical history and your visit.
- Once you have completed the form, review all entries for accuracy. Save any changes made, and then print, download, or share the completed document as needed. Submit the form using the fax number or mailing address provided in your appointment letter.
Make sure to complete your UC Davis Pre-Visit Family History Form online to facilitate a thorough review prior to your appointment.
To get your Medi-Cal records, contact your local Medi-Cal office and request the information you need. You may need to provide personal details and specific identifiers to access your files. Additionally, if you're attending UC Davis, the UC Davis Pre-Visit Family History Form can streamline information sharing, so your healthcare providers have everything they need.