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SUSPECTED CANCER REFERRAL FORM: UPPER GASTROINTESTINAL(Including esophageal, pancreatic, stomach, gallbladder and liver)Date of decision to refer:Date referral received at Trust:Trust name(s) Email
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How to fill out suspected cancer referral form

01
Start by gathering all the necessary patient information such as their name, date of birth, and contact details.
02
Understand the purpose of the suspected cancer referral form and what information needs to be included.
03
Fill out the patient's medical history, including any previous cancer diagnoses or family history of cancer.
04
Provide a detailed description of the patient's symptoms, including when they started and any noticeable changes.
05
Include any relevant test results or imaging studies that have been done to support the suspicion of cancer.
06
Note any risk factors that may contribute to the likelihood of cancer, such as smoking or exposure to certain toxins.
07
Make sure to sign and date the referral form before submitting it to the appropriate healthcare professional.
08
Double-check all the information provided to ensure accuracy and completeness before submitting the form.

Who needs suspected cancer referral form?

01
The suspected cancer referral form is typically needed by healthcare professionals, such as primary care physicians or specialists, who suspect that their patient may have cancer based on their symptoms, medical history, or test results.

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Suspected cancer referral form is a document used to refer patients with potential signs or symptoms of cancer to specialist services for further investigation and management.
Healthcare professionals such as doctors, nurses, and other medical practitioners are required to fill out the suspected cancer referral form for patients exhibiting signs of cancer.
To fill out the suspected cancer referral form, healthcare professionals need to provide detailed information about the patient, their symptoms, medical history, and any relevant test results.
The purpose of suspected cancer referral form is to ensure timely and appropriate referral of patients with potential cancer symptoms to specialist services for further assessment and treatment.
The suspected cancer referral form must include the patient's personal details, relevant medical history, symptoms, examination findings, and any test results that support the suspicion of cancer.
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