Get the free Lung Screening Referral Form & Criteria - Cancer Care Ontario
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Ontario Health Cancer Care Ontario Lung Screening Program Referral Resubmit this completed form to the Ontario Lung Screening Program (LSP) site hospital in your area. Please visit cancercareontario.ca/lungscreeninglocations
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How to fill out lung screening referral form
How to fill out lung screening referral form
01
Obtain the lung screening referral form from your healthcare provider.
02
Fill out your personal information, including name, date of birth, address, and contact information.
03
Provide details about your medical history, including any relevant lung conditions or smoking history.
04
Attach any relevant medical records or test results that may support the need for a lung screening.
05
Submit the completed form to your healthcare provider for review and processing.
Who needs lung screening referral form?
01
Individuals who have a history of smoking or exposure to lung cancer risk factors.
02
Individuals who have symptoms of lung disease such as chronic cough, shortness of breath, or chest pain.
03
Individuals who have been recommended for lung screening by their healthcare provider based on their age or medical history.
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What is lung screening referral form?
The lung screening referral form is a document used to refer individuals for screening tests to detect lung cancer at an early stage.
Who is required to file lung screening referral form?
Healthcare professionals, such as doctors or nurses, are required to file the lung screening referral form for patients who meet the criteria for screening.
How to fill out lung screening referral form?
The form should be filled out with the patient's personal and medical information, as well as the reason for the referral and any relevant clinical information.
What is the purpose of lung screening referral form?
The purpose of the lung screening referral form is to ensure that individuals at high risk for lung cancer are screened in a timely manner to increase chances of early detection and improve outcomes.
What information must be reported on lung screening referral form?
The form should include the patient's name, contact information, medical history, smoking history, and any relevant clinical findings.
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