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How We Do Survivorship care planning in a comprehensive cancer center using an implementation framework Sofa F Garcia, PhD, ABC Sheet M Kirchner, MD, BDE Megan Open, MMS, PAC, e Atari Venus, MMS,
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01
To fill out a survivorship care planning form, follow these steps:
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Start by providing your personal information, including your full name, contact details, and date of birth.
03
Indicate your current medical condition and any previous treatments you have undergone.
04
Provide information about your healthcare providers, including the names of your primary care doctor, oncologist, and any specialists you are seeing.
05
List any medications you are currently taking, including their names, dosages, and frequencies.
06
Include details about any allergies or adverse reactions you have experienced in the past.
07
Describe your medical history, including any relevant diagnoses, surgeries, or procedures you have undergone.
08
Indicate any ongoing symptoms or side effects you are experiencing and their impact on your daily life.
09
Provide information about your lifestyle and habits, such as your diet, exercise routine, and tobacco or alcohol use.
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Include information about your family medical history, particularly if there is a history of cancer or other hereditary conditions.
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Lastly, make sure to sign and date the survivorship care planning form to signify your consent and understanding of the provided information.
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Remember to consult with your healthcare team if you have any questions or need assistance in filling out the form.

Who needs survivorship care planning in?

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Survivorship care planning is beneficial for individuals who have completed their cancer treatment and are transitioning into the post-treatment phase.
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It is particularly important for cancer survivors to have a survivorship care plan if they:
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- Have had a high-risk cancer diagnosis or treatment with potential long-term effects
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- Are at risk for cancer recurrence or developing second primary cancers
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- Require ongoing monitoring and surveillance for cancer-related health issues
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- Experience persistent or late effects of cancer treatment
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- Need guidance on managing physical, emotional, or psychosocial aspects of survivorship
08
- Would like to have a comprehensive summary of their cancer diagnosis, treatment, and follow-up recommendations
09
By having a survivorship care plan, individuals can have a roadmap for their ongoing healthcare needs and improve their overall well-being.
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Survivorship care planning is a coordinated, interdisciplinary plan of care for cancer survivors that addresses medical and psychosocial issues following completion of cancer treatment.
Healthcare providers and facilities involved in the care of cancer survivors are required to create and implement survivorship care planning.
Survivorship care planning is typically filled out by healthcare providers in collaboration with the patient and may include an assessment of the survivor's medical history, treatment received, and ongoing health needs.
The purpose of survivorship care planning is to help cancer survivors transition from active treatment to post-treatment follow-up care, address long-term effects of cancer treatment, and promote overall health and well-being.
Survivorship care planning should include a treatment summary, follow-up care plan, information on potential late effects of cancer treatment, and resources for support and survivorship care.
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