Get the free Suspected melanoma referral form - uhbnhsuk

Referral Form for Suspected Melanoma The rapid access skin cancer diagnosis clinics are designed to provide rapid diagnosis and treatment for suspected skin cancers which have the potential for metastases

How to fill out suspected melanoma referral form

How to fill out suspected melanoma referral form:

1. Start by providing your personal information, such as your name, date of birth, and contact details.
2. Indicate whether you are the patient or if you are filling out the form on behalf of someone else.
3. Specify the reason for the referral, which in this case would be suspected melanoma.
4. Provide a brief medical history, including any previous diagnoses or treatments related to melanoma or other relevant skin conditions.
5. Include any relevant family history of melanoma or other skin cancers.
6. Describe the specific symptoms or concerns that led to the suspicion of melanoma, such as changes in the color, size, or shape of a mole, or any other suspicious skin lesions.
7. If applicable, mention any previous biopsies or tests done related to melanoma.
8. List any medications or allergies that may be relevant to the referral.
9. Include the name and contact information of the referring healthcare provider.
10. Lastly, sign and date the form.

Who needs suspected melanoma referral form?

Patients who exhibit symptoms or have concerns that suggest the presence of melanoma will typically need to fill out a suspected melanoma referral form. This form is usually required by healthcare professionals to provide necessary information about the patient's medical history, symptoms, and any relevant test results. It helps ensure appropriate and timely referrals for further evaluation and potential treatment.

For pdfFiller’s FAQs

What is suspected melanoma referral form?

The suspected melanoma referral form is a document used to refer a patient suspected of having melanoma for further evaluation and treatment.

Who is required to file suspected melanoma referral form?

Healthcare providers, such as doctors, dermatologists, and oncologists, are required to file suspected melanoma referral forms.

How to fill out suspected melanoma referral form?

Suspected melanoma referral forms can be filled out by providing the patient's information, medical history, and reason for suspicion of melanoma.

What is the purpose of suspected melanoma referral form?

The purpose of suspected melanoma referral form is to ensure timely evaluation and treatment of patients suspected of having melanoma.

What information must be reported on suspected melanoma referral form?

Suspected melanoma referral forms must include patient's personal information, medical history, physical examination findings, and reason for suspicion of melanoma.

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