CANCER GENETIC TESTING: FAMILY HISTORY AND APPOINTMENT NOTES Yenra | October 11, 2026 Guide: https://yenra.com/cancer/genetic-testing.html Use this blank worksheet privately before and during a genetics appointment. Copy extra relative entries as needed. Include biological relatives on both sides of the family. Mark unknown or approximate details; an incomplete history is still worth discussing. This is a conversation aid, not a risk calculator or a diagnosis. Do not delay care while gathering records. Prepared on: __________________ Appointment date: ______________________ Clinician / genetics service and contact: ______________________________ My main question: _____________________________________________________ MY HISTORY Cancer or relevant finding / age at diagnosis / report available: _______________________________________________________________________ Prior genetic test (name, lab, date; bring the report if available): _______________________________________________________________________ Any treatment decision waiting on a test? ______________________________ FAMILY HISTORY (repeat this entry for each relative) Relationship (use initials or relationship instead of full name): _______ Family side (mother's / father's / other biological connection): ________ Original cancer type or site, if known: _________________________________ Age at diagnosis (mark approximate if needed): _________________________ Living? ______ Current age, or age at death and cause if known: _________ Known genetic result / report date / permission to obtain copy: _________ _______________________________________________________________________ Information confirmed by report or recalled? What remains unknown? _______________________________________________________________________ History gaps (adoption, limited contact, small family or other): _________ _______________________________________________________________________ Records to bring or request, with the relative's permission: _______________________________________________________________________ QUESTIONS BEFORE TESTING 1. What decision could this test help us make? _________________________ 2. Inherited-risk (germline), tumor testing, or both? ___________________ 3. Should testing start with another relative, if available? ___________ 4. Which genes or known family variant are included, and why? __________ 5. What could positive, negative or uncertain results change? __________ 6. What might the test leave unanswered? _______________________________ 7. Costs: counseling / test / results visit / follow-up? ________________ Prior authorization? Expected personal cost? Contact and date? ____________________________________________________________________ 8. Who stores and sees the result? What sample/data-sharing choices do I have? Which insurance/privacy rules apply to me? _______________ 9. Expected result date and person who will explain it: ________________ AT THE RESULTS VISIT (complete with the clinician) Test / laboratory / report date: _______________________________________ Purpose and genes tested: ______________________________________________ Result wording; gene and exact variant if relevant (attach report): _______________________________________________________________________ What does this establish? What remains uncertain? ______________________ _______________________________________________________________________ For a negative result: was a known family variant excluded? ____________ For a VUS: who handles reclassification updates? ________________________ Screening or care plan, taking history into account: ___________________ _______________________________________________________________________ Which relatives should be offered a genetics conversation? _____________ Is a family letter available? __________________________________________ Next action / responsible person / due date: ___________________________ _______________________________________________________________________ Follow-up contact / when to check back: _________________________________ KEY REMINDER A result needs interpretation in context. A VUS means evidence is uncertain; ask how care will be guided by established findings and history. Keep these notes and your report securely; share only with people you choose. BACKGROUND SOURCES (accessed October 11, 2026) CDC, Family Health History and Cancer: https://www.cdc.gov/cancer/risk-factors/family-health-history.html NCI, Genetic Testing for Inherited Cancer Risk: https://www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testing-fact-sheet More sources and explanations are linked in the guide above.