Get the free SLI BREAST HISTORY FORM - sandlakeimaging.com

SLI BREAST HISTORY FORM Name: Date: MR# DOB: Physician: PLEASE CIRCLE Y N Do you have any CURRENT breast problems or complaint? Describe: Y N Have you had a prior mammogram? When: Where: If your last

How to fill out sli breast history form

How to fill out the SLI Breast History form:

1. Start by carefully reading the instructions provided on the form. This will help you understand the purpose and the information required.
2. Fill in your personal details in the designated spaces. This typically includes your name, date of birth, contact information, and any other relevant identifiers.
3. Provide information about your medical history by answering the specific questions listed on the form. These questions may include any previous breast surgeries, genetic predispositions, or family history of breast cancer.
4. If you have any significant family history related to breast cancer, make sure to include details about your relatives' relationship to you (e.g., mother, sister, aunt) and their age at diagnosis, if applicable.
5. Take note of any additional information requested, such as your reproductive history, hormonal therapy, or previous breast imaging results. Ensure that you enter accurate and up-to-date information.
6. If you have any concerns or specific details you want to communicate to your healthcare provider, use the additional comments section provided on the form. This is an opportunity to express any specific questions or concerns regarding your breast health.

Who needs the SLI Breast History form:

1. Individuals with a family history of breast cancer: The form is often used to assess the risk of developing breast cancer in individuals with a family history of the disease. It helps healthcare providers determine appropriate screening and prevention strategies.
2. Patients undergoing breast cancer treatment: The form may be required to track and document the patient's medical history, including previous treatments, surgeries, and outcomes. This information is useful for ongoing care and treatment planning.
3. Individuals seeking breast health assessment: The form can be used proactively by those who want to understand their risk factors for breast cancer or who may be considering breast cancer screening. It allows healthcare providers to gather detailed information about the individual's medical history and assess their breast cancer risk.

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What is sli breast history form?

The sli breast history form is a document that gathers information about the history of breast cancer in a family.

Who is required to file sli breast history form?

Individuals with a family history of breast cancer are required to file the sli breast history form.

How to fill out sli breast history form?

To fill out the sli breast history form, one must provide details about any family members who have been diagnosed with breast cancer.

What is the purpose of sli breast history form?

The purpose of the sli breast history form is to assess the risk of breast cancer in individuals with a family history of the disease.

What information must be reported on sli breast history form?

The sli breast history form requires information on the number of family members diagnosed with breast cancer, their relationship to the individual, and their age at diagnosis.