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STATE OF NEW HAMPSHIRE DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF PUBLIC HEALTH SERVICES Lori A. Robinette CommissionerBUREAU OF PUBLIC HEALTH STATISTICS AND INFORMATICS Patricia M. Villa Director29
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Obtain a copy of the cancer-terminationpdf form.
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Fill out your personal information, including full name, date of birth, and contact information.
03
Provide details about the type of cancer you have been diagnosed with.
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Include information about your treatment plan and any medications you are currently taking.
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Sign and date the form, certifying that the information provided is accurate.
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Submit the completed form to the appropriate healthcare provider or organization.
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Cancer patients who have been diagnosed with cancer and are seeking to terminate their treatment or make important decisions regarding their care may need the cancer-terminationpdf form.
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Cancer-terminationpdf is a form used for reporting the termination of cancer treatment.
Cancer treatment facilities are required to file cancer-terminationpdf.
Cancer-terminationpdf can be filled out by providing information about the patient, treatment facility, and reason for termination.
The purpose of cancer-terminationpdf is to document and report the termination of cancer treatment.
Information such as patient details, treatment facility information, and reason for treatment termination must be reported on cancer-terminationpdf.
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