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UNC Cancer Network TUMOR BOARD REQUEST FORM Telemedicine Network Phone: (919) 9666820 Tumor Board Case Presentation Date Reason For Consultation: Patient I'd # Presenting Physician Primary Therapy

How to fill out tumor board request form

How to fill out a tumor board request form:

1. Obtain a copy of the tumor board request form from the appropriate source, such as your healthcare provider or hospital.
2. Enter your personal information accurately in the designated fields. This may include your full name, date of birth, contact information, and any relevant medical identification numbers.
3. Provide detailed information about the patient for whom the tumor board review is being requested. Include their name, date of birth, medical history, and any related diagnoses or treatment plans.
4. Specify the reason for the tumor board request. This could be for a new diagnosis, a change in the patient's condition, a treatment plan review, or any other relevant factor that necessitates a comprehensive discussion by a tumor board.
5. Attach any supporting documentation or medical records that are pertinent to the case and could assist the tumor board in their review. This may include pathology reports, imaging studies, biopsy results, or previous treatment plans.
6. Indicate your preferred date and time for the tumor board review, if applicable. Some facilities may provide options to choose from, while others may schedule the board meetings internally.
7. Sign and date the request form to confirm that all the provided information is accurate to the best of your knowledge.

Who needs a tumor board request form:

1. Healthcare professionals involved in the treatment and management of cancer patients, such as oncologists, surgeons, radiologists, pathologists, and other specialists, may need a tumor board request form to facilitate multidisciplinary discussions regarding patient care.
2. Patients or their authorized representatives may also need a tumor board request form if they want to request a comprehensive review of their case by a tumor board. This allows them to benefit from the collective expertise and input of various medical professionals.
3. Hospitals or healthcare institutions that offer tumor board reviews may require the use of a request form as part of their administrative process for scheduling and coordinating these meetings.

Note: The specific requirements for obtaining and using a tumor board request form may vary depending on the healthcare provider or institution. It is advisable to consult with the relevant healthcare professionals or facility to ensure compliance with their procedures and protocols.

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What is tumor board request form?

The tumor board request form is a document used to submit a request for a patient's case to be reviewed by a multidisciplinary team of experts.

Who is required to file tumor board request form?

Medical professionals involved in the care of the patient are required to file the tumor board request form.

How to fill out tumor board request form?

To fill out the tumor board request form, medical professionals need to provide detailed information about the patient's case and submit it to the appropriate department.

What is the purpose of tumor board request form?

The purpose of the tumor board request form is to facilitate collaboration among healthcare providers and ensure that patients receive comprehensive care.

What information must be reported on tumor board request form?

The tumor board request form must include information about the patient's medical history, diagnosis, treatment plan, and any relevant test results.