Genogram Example Template
Appendix 7
Genogram example
Genogram symbols
Male Female Gender unknown Death
(e.g. pregnancy)
Genogram symbols
Enduring
relationship
(marriage or
cohabitation)
Separation
Transitory
Relationship
Divorce
First child Second child Miscarriage or Twins
abortion
A dotted line should be drawn around the people who currently live in the same house.
Significant people in a child’s life should be shown and dotted lines to these
Dated 01/10/2012
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