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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          
Heart Disease          
           
           
           
Diabetes          
Stroke          
Pulmonary Disorders:          
-Asthma          
-Emphysema          
Organ Disorders          
Arthritis          
Congenital Disorders (list):          
           
           
           
Multiple Births          
Stillbirths          
Spontaneous Abortions          
Other (list):          
           
           
           

 


 

Featured Sites:

Cord Blood Registry
March of Dimes
Susan G. Komen


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