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Michael B. Lofts, DDS, P.A.204 B. West Arlington Blvd. Greenville, NC 27834 (252) 6892762 (252) 6892764 Fax Greenvillerootcanalspecialists.combat: Ref. Doctor Patient Name Patient MOBILE NumberORPatient
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How to fill out familial cancer program referral
How to fill out familial cancer program referral
01
Obtain the familial cancer program referral form from the healthcare provider or institution
02
Fill in the patient's personal information, such as name, date of birth, and contact details
03
Provide relevant medical history information, including any known familial cancer cases
04
Answer the questionnaire regarding family history of cancer, including details on close relatives
05
Include any additional relevant medical reports or test results
06
Sign and date the referral form
07
Submit the completed form to the designated healthcare provider or institution
Who needs familial cancer program referral?
01
Individuals who have a family history of cancer or are at a higher risk of developing cancer may need a familial cancer program referral. This includes individuals with close relatives who have had a diagnosis of cancer, especially if multiple family members are affected or if the cancer occurred at a younger age than usual. Additionally, individuals with known genetic mutations associated with an increased risk of cancer may also benefit from a familial cancer program referral.
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What is familial cancer program referral?
Familial cancer program referral is a process of referring individuals who have a family history of cancer to a specialized program for further evaluation and monitoring.
Who is required to file familial cancer program referral?
Healthcare providers or genetic counselors are required to file familial cancer program referral for individuals with a family history of cancer.
How to fill out familial cancer program referral?
To fill out familial cancer program referral, healthcare providers or genetic counselors need to gather the family history information, complete the referral form, and submit it to the designated program.
What is the purpose of familial cancer program referral?
The purpose of familial cancer program referral is to identify individuals who may be at increased risk of developing cancer due to their family history, and provide them with specialized care and monitoring.
What information must be reported on familial cancer program referral?
Familial cancer program referral must include detailed family history of cancer, individual's medical history, genetic testing results (if available), and any other relevant information.
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