Male Female a) rr\-/v/

Therapy or

Tr a\
HeterosexUal

Pet

lnstitutional
Connection

Famly

Seeret

Household shown by circling msmbsrs lving t0gsthsr (c0uple living with their dog after launching children)

TA
Has Livcd in
,

lfTl

:) /f7l \._/ tvt w_/ r. Gay Lesbian Bisexual

Transgender PeoPle

lmmigration 2+Cultures
-,fr.l
1

,h.

i-) \./
man to

n f82'

L__t
'{

A LI
I

grimary genogram members

woman

written lower than siblings

woman to man

Death
r94r-200r

!ocation
Bostoil

&

Birth 0ate

Alt

Annual lncome
$r00,000

,''

tl
above symD0l *When

E
tn5t0e
symD0t

and age at death tn synbol, death date above*

X

Gens Third

72-

above birth date

o
|

identified patient (lP)

synbol has double line

and is written lower than siblings

multiple deceased generat\rs are included, use an X lnly fqt untmely death

Tt LJ
Marital Separation Marital Reconciliation 0ivorce

Committsd Relationship rrqq

Adopted child/Foster child

l;-_:::-ll

a) V
use an

Reconciliation

e6 q) tr L---X----r
se5

Alter Separatiot-

alrcw tu snow lamtty nto which child moved

FQ w

XT\rs4
adopted ar

nr

i0

s 95, rl 97

0onor Insamination 0ivorce and Remarriage

m 80, s 85-86 d

90 rentar 93. rediv

94

list n birth oer

LW

with the oldest on lelt

94;

98-

ol
Stillbirth inf0rmatioI l\4iscarriage Ab0rtl0n
Adopted chld unknown

o3

Ltl.j
Foster

ldentrcal
twins

Pregnancy

lesban couple's gay cluple s daui':. daughter conceived c1nceved with sPi'' of one Partner :.: with egg of paftnet egg donu, cane: bY sunogate nott't' sperm

one and donor

child

lnteractional Patterns Between People

Addiction, Physical or ltlental lllness or other Problem

|

CF--IO
Focused on

Ll-----l-l -Close

l|_

lE.-l
Fused

Physical or psychological illness

,. !./ /1 V -fr v

Physical or psychologrcl

rllness in remission

t]^A
Hostrle

Cr--f
Close-hostile

C*"+{l
Focused

Substance abuse

co
0istant

on negatvely

fl

LF TAI
Cutofi*

rr rfl

l----] r

ln tecovery from substance abuse

L_r.s-1l

l---.]

a
l-l f-l

Suspected

Substance abuse Serious mental or physical problems and substance abuse smoker
Language difficulty (person does not sPeak [--l I lr dominantlanguage of the countrY)

r>3
Caretaker

Cutoff repaired

Ch^ O
Sprilual connection
or

n----fl UU
Positive relationship

ln recovery from mental or Dhvsical oroblems and lrom substance abuse

affinity

tl^

>C
shows dtrecttons

3'ADC
Emotional abuse

n4C
Sexual Abuse

Physrcal abuse

oesity

hx)w (aptnnal)