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Appendix L MEDICAL ONCOLOGY Authorization FORM FOR EXTERNALLY FUNDED PATIENTS TREATED AT PUBLIC HOSPITALS EFFECTIVE 01 APRIL 2016 Hospital Name: Hospital Practice No: Hospital Tel: Attending Dr: Practice

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How to fill out annexure l oncology authorizationfor

01

To fill out annexure l oncology authorization form, follow these steps:

02

Start by entering the date of the form in the specified field.

03

Provide the name of the patient who requires oncology authorization.

04

Enter the patient's ID or medical record number.

05

Specify the type of cancer that the patient is diagnosed with.

06

Indicate the recommended treatment for the patient's condition.

07

Provide any additional notes or information related to the patient's oncology treatment.

08

Enter the name of the authorized medical practitioner who is recommending the treatment.

09

Include the practitioner's contact details, such as phone number and email address.

10

If applicable, provide the signature of the authorized medical practitioner.

11

Review the filled-out form for accuracy and completeness before submission.

Who needs annexure l oncology authorizationfor?

01

Annexure l oncology authorization form is required by patients who have been diagnosed with cancer and need authorization for oncology treatment.

02

This form is typically used by medical practitioners or healthcare providers to authorize and document the recommended oncology treatment for the patient.

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What is annexure l oncology authorization for?

Annexure l oncology authorization is for obtaining approval for oncology treatment.

Who is required to file annexure l oncology authorization?

Healthcare providers and hospitals are required to file annexure l oncology authorization.

How to fill out annexure l oncology authorization?

Annexure l oncology authorization can be filled out by providing patient information, treatment details, and medical history.

What is the purpose of annexure l oncology authorization?

The purpose of annexure l oncology authorization is to ensure that oncology treatments are properly authorized and documented.

What information must be reported on annexure l oncology authorization?

Information such as patient name, treatment plan, diagnosis, and medical records must be reported on annexure l oncology authorization.

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