Sample Follow-Up Letter #1

Sample Follow-up Letter #1

Sample Follow-up Letter to Physicians

To:	James Smith, M.D.	Date of letter:	1/1/02
	123 Any Street
	Anytown, XX 99999	Last follow-up date:
		Other hospital #


From:	John Doe, MD	Re: Doe, Jane Mary
	Chair, Cancer Committee	Date of birth: 1/1/40
		Diagnosis: Breast CA
		TR#: 910123/00 (Accession and Sequence)

An annual follow-up of registered cancer cases seen at Anytown Medical Center is conducted by the Cancer Registry. We would appreciate receiving the latest information you have on the patient listed above. Please direct questions to the Cancer Registry at (999) 555-9999.

Patient Status:

1. Alive -- Date last seen or contacted: _______________________________

A.	Status of Neoplasm:		B.	Quality of Survival:
	No evidence of cancer	________		Normal activity	________
	With evidence of cancer	________		Symptomatic and
				ambulatory	________

	Cancer status unknown	________		Ambulatory more than
				50%, occasionally
				needs assistance	________
	New areas of recurrence
	and/or metastasis	________		Ambulatory less than
				50%, nursing care
	Site: __________________			needed	________
				Unknown	________

C.	Additional therapy within the last year
	Surgery: ________________________	Date: ___________________
	Radiation: site ________ rads: ______	Date: ___________________
	Chemotherapy: ___________________	Date: ___________________
	Hormone therapy: _________________	Date: ___________________
	Immunotherapy ___________________	Date: ___________________
	Other: __________________________	Date: ___________________

Patient referred to: _____________________________________________
New patient address: ____________________________________________ Comments: _____________________________________________________

2.	Expired -- Place: __________________	Date: ___________________
	Cause of death: __________________	Autopsy? ______ Yes ______ No