Medical History Organizer
Pregnancy and parenthood involve lots of trips to the doctor’s office and dozens of questions regarding personal and family medical history. It can be difficult to keep track of all this vital information so we’ve create the following handy chart for you to complete, print and keep in your files for easy reference.
| Condition |
Mother |
Father |
Maternal Grandparents |
Paternal Grandparents |
Sibling(s) |
| Hypertension/High Blood Pressure |
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| Heart Disease |
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| Diabetes |
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| Stroke |
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| Pulmonary Disorders: |
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| -Asthma |
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| -Emphysema |
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| Organ Disorders |
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| Arthritis |
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| Congenital Disorders (list): |
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| Multiple Births |
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| Stillbirths |
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| Spontaneous Abortions |
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| Other (list): |
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