Get the free Familial Cancer Program Referral Form - Healthy WA

Familial Cancer Program Referral Form Most cancers are not hereditary and not everyone with a personal and/or family history of cancer is eligible for public genetic services. Prior to making a referral,

How to fill out familial cancer program referral

How to fill out familial cancer program referral

1. To fill out a familial cancer program referral, follow these steps: 1. Obtain the referral form from the familial cancer program.
2. Fill out the patient's personal information, including their name, date of birth, contact information, and any relevant medical history.
3. Provide details about the patient's family history of cancer. Include information about any close relatives who have been diagnosed with cancer and their relationship to the patient.
4. Indicate any genetic testing that has been conducted on the patient or their family members, if applicable.
5. Include any other relevant medical information or concerns in the referral form.
6. Sign and date the referral form.
7. Submit the completed referral form to the familial cancer program either in person, by mail, or through any specified online submission process.
8. Keep a copy of the referral form for your records.

Who needs familial cancer program referral?

1. A familial cancer program referral is typically needed for individuals who have a personal or family history of cancer and require specialized care or genetic testing.
2. This referral is typically required for patients who may be at higher risk for hereditary cancer syndromes, such as those with a family history of multiple cases of the same or related cancers.
3. Additionally, individuals who have already been diagnosed with cancer but have not undergone genetic testing may also benefit from a familial cancer program referral.

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What is familial cancer program referral?

A familial cancer program referral is a process by which individuals, particularly those with a family history of cancer, are referred to specialized genetic counseling and testing services to assess their risk for hereditary cancers.

Who is required to file familial cancer program referral?

Individuals with a personal or family history of certain cancers that may indicate a hereditary cancer syndrome are typically required to file a familial cancer program referral.

How to fill out familial cancer program referral?

To fill out a familial cancer program referral, you generally need to provide personal information, details about family history of cancer, and information about previous medical consultations and genetic tests, if any.

What is the purpose of familial cancer program referral?

The purpose of familial cancer program referral is to identify individuals at increased risk for hereditary cancers and to provide them with access to preventive measures, screenings, and informed decision-making regarding their health.

What information must be reported on familial cancer program referral?

The information typically reported includes personal demographic details, family history of cancer (types and ages at diagnosis), relevant medical history, and any previous genetic test results.