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PATIENT REFERRAL FORM Outpatient Oncology New Patient Referral Juravinski Cancer Centre 699 Concession Street Hamilton ON L8V 5C2 Please COMPLETE ALL INFORMATION and FAX TO 905-575-6316 WITH ALL RELATED REPORTS. http //www. Jcc.hhsc.ca/body. cfm id 131 Please Print Patient s Name M Health Card Number or non-OHIN information F Date of Birth dd/mm/yy Version Code Language if English not spoken City Province Postal Code Phone primary Phone secondary Address Patient Location Institution Home...
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Who needs accessing our cancer treatment?

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Individuals who have been diagnosed with cancer and are seeking effective treatment options
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Accessing our cancer treatment involves patients receiving treatment and care for cancer from healthcare providers and facilities.
Patients who are receiving cancer treatment are required to fill out accessing our cancer treatment forms.
Accessing our cancer treatment forms can be filled out by providing information about the type of treatment received, healthcare providers involved, and any side effects experienced.
The purpose of accessing our cancer treatment is to track the care and treatment received by cancer patients in order to improve quality of care and outcomes.
Information such as treatment received, healthcare providers involved, side effects experienced, and outcomes must be reported on accessing our cancer treatment forms.
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