Family Health History: Genogram
1. Family Health History: Genogram
For the purposes of this assignment a genogram is a pictorial representation of social and medical
conditions within a family. You will complete a 4-page paper (including title page) related to your
family’s health history or the fictional family that you have created. The “My Health Goals” form must
be used to complete the assignment. Narrative papers are not acceptable and will result in a grade
reduction.
There are two options in completing the health history assignment. You can explore your own family
health history or you can use a fictional family of your own creation. All families (whether a fictional or
your own family) must include an index person, a sibling of the index person (if applicable when using a
real family), parents and two sets of grandparents. For a fictional family, create a family health history
by identifying social and medical problems for members of the family. Please, keep in mind that the
potential health problems must be related to the health problems noted in the fictional family. When
conducting the family history on your actual family, you should attempt to obtain information by
interviewing your parents, grandparents, and other family members to determine diseases, social
conditions and medical conditions that are present in the family.
Once you have obtained or determined the health history, construct a genogram by using appropriate
symbols. Consider yourself or a fictious you as the “index” person. The index person is the focus of the
family history. You are creating the family history to see how the health of the family impacts the index
person. Be sure to include a legend which includes all symbols used in the genogram. Examples of
symbols are located on the course site in iCollege.
IMPORTANT: The family health history must be completed on the form provided and according to the
instructions provided. If the assignment is not completed on the My Health Goals form, the
assignment grade will be reduced one letter grade. Do not complete assignment in narrative,
paragraph format.
Submit the assignment by the due date in the iCollege assignment folder.
PLEASE NOTE: If you are completing a personal family health history, the requested
information may contain information that you do not wish to share. The information in the
genogram will be kept confidential. However, you are free to omit any information that you feel
uncomfortable sharing. You also have the option of creating a fictional family or fictious
conditions. If you have concerns about the assignment or have trouble obtaining the needed
information, contact me to discuss options.
The genogram should include the following components where relevant:
The genogram may be handwritten and drawn
Must be submitted via iCollege dropbox
At least 3-4 generations (i.e. an index person, siblings, parents & their siblings, & grandparents). If the
index person has children, there will be four generations.
Consider yourself or a fictious you as the “index” person.
Current and past health status of included family members
Date of birth of family members
Cause of death and date of death (when applicable)
Illnesses, chronic medical conditions, birth defects, mental disabilities, physical malformations
Reproductive history– miscarriages, stillbirths, pregnancy-related medical problems
Usage of appropriate symbols, with a legend
NOTE: If onset of illness/condition, cause of death, or age of death are unknown, notate “Date Unk.”
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Revised August 2021
Page 1: Title Page
The title page should include the following APA guidelines and must be typewritten.
Family Health History
Your Name
Course Number: NURS 2010
Georgia State University
Current semester (i.e. fall, spring or summer) 2021
Date:
Page 2: Genogram
1. Include the genogram with symbols
2. The genogram can be hand- drawn.
Pages 3-4: My Health Goal
Note: Use the “My Health Goals” form to complete this portion of the assignment. Pages 3-4 must be
typewritten.
1. Identify 4 health risks from the genogram.
2. Based on the family history focus on 3 health risks you (or the fictional index person) want to target. If
there are no health risks, specifies possible health risks that come as an individual ages (examples:
obesity, high blood pressure, arthritis). See chapters on middle adulthood.
3. Identify 2 or more personal health goal(s).
4. List 3 things you will do to reach your personal health goals in light of your personal (or the fictional
index person’s) health risks.
5. Using Erikson’s theory, identify the index person’s present stage of development. Identification of the
stage of development is determined by the index person’s age.
6. Describe how the index person’s stage of development will affect the achievement of the identified health
goals.
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Revised August 2021
My Health Goals Form
Health Risks based on family history:
1. _______________________________________________________________________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
4. _______________________________________________________________________________
Health risks that I want to target:
1. _______________________________________________________________________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
Health goals:
1. _______________________________________________________________________________
2. _______________________________________________________________________________
How goals will be achieved:
1. _______________________________________________________________________________
2. _______________________________________________________________________________
3. _______________________________________________________________________________
Based on the Index person’s age identify the stage of development according to Erikson’s Theory
of development:
_________________________________________________________________________________
Describe how the current developmental stage impacts the index person’s ability to achieve the
stated health goals. Only 2 to 3 paragraphs are needed for this section. This section may carry
over to page 4.
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