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SPOKANE REGIONAL HEALTH DISTRICT
PHONE 5093232851
FAX 5093241599
WWW.RHD.ORG DOH 345211 June 2018Breast Diagnostic Form
CLIENT NAME (Last, First, MI)BC CHP ID#:
Authorization #:
SOCIAL SECURITY NUMBER
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How to fill out breastdxform-doh345-211-june2018 form for recording
How to fill out breastdxform-doh345-211-june2018 form for recording
01
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Read the instructions thoroughly before filling out the form to ensure complete understanding.
03
Begin filling out the form by entering the necessary personal information, such as name, contact details, and date of birth.
04
Provide accurate medical information, including previous diagnoses, treatments, and medications.
05
Clearly indicate any current symptoms or concerns related to breast health.
06
If applicable, provide details of any previous surgeries or procedures related to breast health.
07
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Individuals who require a formal record of their breast health and medical history may need the breastdxform-doh345-211-june2018 form for recording.
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What is breastdxform-doh345-211-june2018 form for recording?
The breastdxform-doh345-211-june2018 form is used for recording and reporting breast cancer diagnosis information.
Who is required to file breastdxform-doh345-211-june2018 form for recording?
Healthcare providers and facilities that diagnose and treat breast cancer patients are required to file the breastdxform-doh345-211-june2018 form for recording.
How to fill out breastdxform-doh345-211-june2018 form for recording?
The form can be filled out manually by providing the requested information in the designated fields. Alternatively, some facilities may use electronic systems to input the data.
What is the purpose of breastdxform-doh345-211-june2018 form for recording?
The purpose of the form is to collect and report accurate data on breast cancer diagnoses in order to track trends, monitor outcomes, and improve patient care.
What information must be reported on breastdxform-doh345-211-june2018 form for recording?
The form typically requires information such as patient demographics, tumor characteristics, treatment modalities, and follow-up care.
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