Get the free BREAST CLINIC REFERRAL FORM - London Cancer

DOB: NHS no: PRACTICE CODE: BREAST CLINIC REFERRAL FORM Press the Ctrl key while you click here to VIEW REFERRAL GUIDELINES REFERRAL DATE: For all breast referral snot only 2ww cancer referrals For

How to fill out breast clinic referral form

How to fill out a breast clinic referral form:

1. Start by carefully reading the instructions provided on the form. Make sure you understand the purpose of the form and what information is required.
2. Begin by filling in your personal details such as your full name, date of birth, address, and contact information. Provide accurate and up-to-date information to ensure proper communication.
3. If applicable, provide details regarding your referring healthcare professional, including their name, contact information, and any relevant medical practice or institution they are associated with.
4. In the section asking for your medical history, provide a comprehensive overview of any previous breast-related issues, surgeries, or treatments you have undergone. Include relevant dates and names of healthcare providers involved in your care.
5. Specify the reason for requesting the referral to the breast clinic. Describe any specific concerns, symptoms, or abnormalities you have noticed. Be clear and concise in your description, providing relevant details that may help healthcare professionals in assessing your situation.
6. If you have any relevant medical records, diagnostic test results, or imaging reports, make sure to attach copies to the referral form or provide instructions on how to access them. This will help the breast clinic specialists gain a better understanding of your medical history and assist in their evaluation.
7. Review the completed form thoroughly to ensure accuracy and completion. Double-check all the information provided, making sure there are no missing or incorrect details. Mistakes or omissions may result in delays or confusion during the referral process.

Who needs a breast clinic referral form:

1. Women who have noticed any changes or abnormalities in their breasts that may require further evaluation or treatment.
2. Individuals who have been recommended by their healthcare provider to seek specialized breast-related care due to specific concerns, symptoms, or risk factors.
3. Individuals who have been referred as part of routine breast cancer screening or follow-up procedures, typically based on age or previous medical history.

Remember, the necessity of a breast clinic referral form may vary depending on specific healthcare systems and practices. It is always best to consult with your healthcare provider or contact the breast clinic directly for guidance on when and how to complete the referral form.

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What is breast clinic referral form?

It is a form used to refer patients to a breast clinic for further evaluation and treatment of breast concerns.

Who is required to file breast clinic referral form?

Healthcare providers, such as general practitioners, gynecologists, or oncologists, are required to file the breast clinic referral form for their patients.

How to fill out breast clinic referral form?

The form typically requires basic patient information, reason for referral, medical history, and any relevant test results.

What is the purpose of breast clinic referral form?

The purpose of the form is to ensure that patients with breast concerns are evaluated by specialists at a breast clinic for accurate diagnosis and appropriate treatment.

What information must be reported on breast clinic referral form?

Patient demographics, reason for referral, relevant medical history, current medication, test results, and any other supporting documentation.