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BREAST CANCER SCREENING EXCLUSION FORM Fax to Quality Department, attn: Christine Hillman, RN at 2483314519 My patient DOB has been incorrectly identified as needing a mammogram for breast cancer
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01
Begin by opening the breastcancerscreeningexclusion2012doc document on your computer or printing a physical copy.
02
Make sure you have all the necessary information and documentation required to complete the form, such as personal identification details, medical history, and any relevant test results.
03
Start by carefully reading the instructions provided in the document. This will give you a clear understanding of what information needs to be provided and how to proceed.
04
Fill in your personal details accurately, including your name, address, contact number, and any other requested identifying information.
05
Proceed to the medical history section and answer the questions honestly and to the best of your knowledge. If you are unsure about any specific medical details, consult with your healthcare provider for clarification.
06
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Submit the filled-out breastcancerscreeningexclusion2012doc form as required, whether it is through electronic means or by mailing it to the appropriate address.
Who needs breastcancerscreeningexclusion2012doc?
01
Individuals who have been advised by their healthcare provider to exclude breast cancer screening for specific reasons, such as individuals with a previous history of breast cancer or certain genetic mutations.
02
Women who have undergone a bilateral mastectomy or have had both breasts surgically removed.
03
Patients who have chosen to opt-out of breast cancer screening due to personal beliefs or preferences.
04
Individuals who have been diagnosed with a terminal illness and have other priorities for their medical care.
05
Patients who have previously received radiation therapy to the chest area, making breast cancer screening less effective or unnecessary.
06
Individuals who are under the age recommendation for routine breast cancer screening according to recognized medical guidelines.
07
People who have been determined to have a high risk of false-positive results, leading to unnecessary diagnostic interventions and stress.
08
Patients who have discussed the potential risks and benefits of breast cancer screening with their healthcare provider and have made an informed decision to exclude it.
09
Individuals who have already completed their recommended breast cancer screening according to the established guidelines and do not need to repeat it at the current time.
10
Patients who have any other specific medical or personal reasons that justify their exclusion from breast cancer screening, as determined by their healthcare provider.
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What is breastcancerscreeningexclusion2012doc?
The breastcancerscreeningexclusion2012doc is a document used to exclude individuals from breast cancer screening programs based on specific criteria.
Who is required to file breastcancerscreeningexclusion2012doc?
Healthcare providers or organizations running breast cancer screening programs are required to file the breastcancerscreeningexclusion2012doc.
How to fill out breastcancerscreeningexclusion2012doc?
The breastcancerscreeningexclusion2012doc should be filled out with the necessary information regarding the individual being excluded from the screening program.
What is the purpose of breastcancerscreeningexclusion2012doc?
The purpose of the breastcancerscreeningexclusion2012doc is to maintain accurate records of individuals excluded from breast cancer screening programs.
What information must be reported on breastcancerscreeningexclusion2012doc?
The breastcancerscreeningexclusion2012doc should include the individual's name, reason for exclusion, date of exclusion, and any relevant medical information.
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