Current age of mother
Age at death
Does your mother have any illnesses? If so, which?
Illnesses during lifetime and cause of death
Current age of father
Age at death
Does your father have any illnesses? If so, which?
Illnesses during lifetime and cause of death:
Current age of child (1)
Age at death of child (1)
Does this child (1) have any illnesses? If so, which?
Illnesses during lifetime and cause of death:
Current age of child (2)
Age at death of child (2)
Does this child (2) have any illnesses? If so, which?
Illnesses during lifetime and cause of death:
Current age of child (3)
Age at death of child (3)
Does this child (3) have any illnesses? If so, which?
Illnesses during lifetime and cause of death:
Current age of child (4)
Age at death of child (4)
Does this child (4) have any illnesses? If so, which?
Illnesses during lifetime and cause of death:
Current age of sibling (1)
Age at death of sibling (1)
Does this sibling (1) have any illnesses? If so, which?
Illnesses during lifetime and cause of death:
Current age of sibling (2)
Age at death of sibling (2)
Does this sibling (2) have any illnesses? If so, which?
Illnesses during lifetime and cause of death:
Current age of sibling (3)
Age at death of sibling (3)
Does this sibling (3) have any illnesses? If so, which?
Illnesses during lifetime and cause of death:
Current age of sibling (4)
Age at death of sibling (4)
Does this sibling (4) have any illnesses? If so, which?
Illnesses during lifetime and cause of death: