Get the free CANCER GENETICS REFERRAL FORM - cancerni.net

Northern Ireland Regional Genetics Center Cancer Genetics Service, A Floor, Belfast City Hospital Lisbon Road, Belfast BT9 7AB Fax: 028 9023 6911 Consultants in Clinical Genetics Prof Patrick J Morrison

How to fill out cancer genetics referral form

How to Fill Out a Cancer Genetics Referral Form:

1. Start by identifying the patient's personal information, such as their full name, date of birth, and contact details. This will ensure that the referral is correctly linked to the right individual.
2. Provide a brief medical history of the patient, which might include any previous diagnoses, treatments, or surgeries related to cancer. This information will help the genetics specialist evaluate the patient's risk factors accurately.
3. Include relevant family history details. This involves documenting any instances of cancer or genetic conditions among close relatives, such as parents, siblings, and children. Include the type of cancer, the age of diagnosis, and any genetic testing results if available.
4. Describe the reason for the referral. This section should explain the primary concern or indication that led to the recommendation for genetic counseling or testing. It could be a personal or family history of a specific type of cancer, early-onset cases, or other factors that may increase the individual's risk.
5. Indicate the type of genetic test or counseling being sought. This might include a comprehensive hereditary cancer panel, single gene testing, or a discussion of genetic risk assessment. Specify if the referral is for the patient alone or if there is a family member who also needs evaluation.
6. Submit any relevant documentation, such as copies of previous genetic test results or medical records that support the need for genetic counseling. These additional documents can provide important insights into the patient's condition and guide the subsequent steps.
7. Include the referring healthcare provider's information, including their name, contact information, and any relevant affiliations or specialties. Providing accurate and up-to-date contact details ensures that the genetics clinic can easily communicate with the referring physician if needed.

Who Needs a Cancer Genetics Referral Form:

1. Individuals with a personal or family history of cancer might require a cancer genetics referral form. This form helps assess their genetic risk factors and determines if genetic counseling or testing is necessary.
2. Individuals with a family history of early-onset cancers, multiple relatives diagnosed with cancer, or specific types of cancer associated with known genetic mutations may benefit from genetic evaluation.
3. Patients who have already been diagnosed with cancer might also need a cancer genetics referral form, as genetic testing can provide information about their cancer's underlying causes and potential treatment options.

In summary, filling out a cancer genetics referral form involves documenting the patient's personal information, medical and family history, stating the reason for the referral, specifying the type of genetic testing or counseling required, and submitting necessary supporting documents. This form is necessary for individuals with a personal or family history of cancer, especially those with specific risk factors that indicate a potential genetic component to their condition.

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What is cancer genetics referral form?

The cancer genetics referral form is a document used to refer patients to genetic counseling and testing for hereditary cancer risk.

Who is required to file cancer genetics referral form?

Healthcare providers such as doctors, genetic counselors, and oncologists are required to file the cancer genetics referral form for their patients.

How to fill out cancer genetics referral form?

The cancer genetics referral form is typically filled out by providing patient information, family history of cancer, and reason for referral to genetic counseling.

What is the purpose of cancer genetics referral form?

The purpose of the cancer genetics referral form is to help identify individuals at risk for hereditary cancer syndromes and provide them with appropriate genetic counseling and testing.

What information must be reported on cancer genetics referral form?

The information that must be reported on the cancer genetics referral form includes patient demographics, cancer history in the family, and reason for referral.