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Extended Breast Questionnaire Patient Name: Date: Diagnosed with breast cancer: Cancer type: Metastatic Local Lymph node involvement When diagnosed: Month Year when (left breast): UO UI LO LI Nipple

How to fill out extended breast questionnaire

How to fill out extended breast questionnaire

1. Here are the steps to fill out the extended breast questionnaire:
2. Start by reviewing the questions in the questionnaire to get familiar with the content.
3. Read each question carefully and provide honest and accurate answers.
4. If a question requires a specific format or type of response, make sure to follow those instructions.
5. Take your time to reflect on each question and provide thoughtful responses.
6. If you are unsure about a question or need further clarification, reach out to the appropriate healthcare professional or administrator for assistance.
7. Once you have completed all the questions, review your answers to ensure they are complete and accurate.
8. Finally, submit the completed extended breast questionnaire according to the instructions provided.

Who needs extended breast questionnaire?

1. The extended breast questionnaire is intended for individuals who require a detailed assessment of their breast health.
2. This may include individuals who have a family history of breast cancer, individuals experiencing breast-related symptoms or concerns, or those undergoing breast health screenings.

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What is extended breast questionnaire?

The extended breast questionnaire is a form that gathers information regarding breast health and history.

Who is required to file extended breast questionnaire?

Individuals who have a history of breast cancer or other breast-related issues may be required to file an extended breast questionnaire.

How to fill out extended breast questionnaire?

The extended breast questionnaire can typically be filled out online or in person at a medical facility. It will ask for detailed information about breast health history.

What is the purpose of extended breast questionnaire?

The purpose of the extended breast questionnaire is to gather comprehensive information about an individual's breast health, which can be used for medical assessment and treatment planning.

What information must be reported on extended breast questionnaire?

Information such as family history of breast cancer, personal breast health history, and any previous breast surgeries or treatments may need to be reported on the extended breast questionnaire.