Get the free Thoracic Oncology Program Referral Form - Dartmouth-Hitchcock - med dartmouth-hitchcock

DMC use only Apt. Date: Apt. Time: Phone: (603) 650-6344 Fax: (603) 650-9496 Comprehensive Thoracic Oncology Program www.cancer.dartmouth.edu Referral Form Patient Name: Last First MI DOB: DMC MR#:

How to fill out thoracic oncology program referral

How to fill out a thoracic oncology program referral:

1. Begin by gathering all necessary patient information, including their full name, date of birth, and contact information. This information is vital for the referral process.
2. The next step is to obtain the patient's medical history relevant to their thoracic oncology condition. This may include previous diagnoses, treatments, and any relevant test results. It is crucial to include as much information as possible to help the receiving program accurately assess the patient's case.
3. Provide a detailed description of the patient's current condition, including presenting symptoms, duration, and any changes or progression observed. Include any relevant imaging reports or biopsy results if available.
4. It is important to mention any coexisting medical conditions or medications that the patient is currently taking. This information can give the thoracic oncology program a more comprehensive view of the patient's overall health and help them tailor their treatment plan accordingly.
5. Specify the reason for the referral to a thoracic oncology program. This could be due to a suspected or confirmed diagnosis of lung cancer, pleural mesothelioma, or any other thoracic malignancy. Clearly state the goals of the referral, such as seeking a second opinion or initiating specialized treatment.

Who needs thoracic oncology program referral:

1. Patients who have been diagnosed with a thoracic malignancy such as lung cancer or pleural mesothelioma may require a referral to a thoracic oncology program. These programs have the expertise and resources necessary to provide specialized care for these specific types of cancers.
2. Individuals who have undergone initial treatments for thoracic malignancies but are looking for a second opinion or exploring additional treatment options may benefit from a thoracic oncology program referral. These programs can offer advanced therapies, clinical trials, and personalized treatment plans based on the patient's unique case.
3. Patients whose primary care physicians or oncologists believe would benefit from the specialized care and expertise provided by thoracic oncology programs may also be referred. These programs often have a multidisciplinary team involving medical oncologists, thoracic surgeons, radiation oncologists, and other specialists who can collaborate to develop the most effective treatment plan.

In summary, the process of filling out a thoracic oncology program referral involves gathering patient information, providing a comprehensive medical history, describing the current condition, and specifying the goals of the referral. Referrals may be necessary for patients with thoracic malignancies, those seeking a second opinion, or individuals whose primary healthcare providers believe they would benefit from specialized thoracic oncology care.

For pdfFiller’s FAQs

Where do I find thoracic oncology program referral?

The premium subscription for pdfFiller provides you with access to an extensive library of fillable forms (over 25M fillable templates) that you can download, fill out, print, and sign. You won’t have any trouble finding state-specific thoracic oncology program referral and other forms in the library. Find the template you need and customize it using advanced editing functionalities.

Can I sign the thoracic oncology program referral electronically in Chrome?

As a PDF editor and form builder, pdfFiller has a lot of features. It also has a powerful e-signature tool that you can add to your Chrome browser. With our extension, you can type, draw, or take a picture of your signature with your webcam to make your legally-binding eSignature. Choose how you want to sign your thoracic oncology program referral and you'll be done in minutes.

Can I edit thoracic oncology program referral on an iOS device?

Use the pdfFiller mobile app to create, edit, and share thoracic oncology program referral from your iOS device. Install it from the Apple Store in seconds. You can benefit from a free trial and choose a subscription that suits your needs.