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Sample Follow-up Letter #2

Letter That Can Be Sent to Nursing Home or Convalescent Hospital

Date of Letter: 1/1/02

Care Convalescent Home
1234 Any Street
Anytown, XX 99999

A follow-up is conducted annually by the Cancer Registry of all patients treated at Anytown Medical Center with a diagnosis of cancer is conducted by the Cancer Registry. Our records show that the patient listed below was transferred to your facility. To complete our records, we would appreciate information regarding this patient. Any questions may be directed to the Cancer Registry at (999) 555-9999.

Sincerely,

John Doe, M.D.
Chair, Cancer Committee

Re: Doe, Jane Mary
Last Follow-up Date:
Date of Birth: 1/1/50

Accession Number/Sequence:
Diagnosis: Breast CA

Patient Status:

  1. Alive

    Still in your facility: Yes _______ No _______

    If answer is no:

    Date Transferred:
    _______________________________________________________

    Transferred to:
    _______________________________________________________

    1. Status of Neoplasm
    2. Quality of Survival
  2. Expired

    Place:
    ______________________________________________________

    Date:
    ______________________________________________________

    Cause of Death:
    ______________________________________________________

    Autopsy: Yes _______ No _______

Comments:
___________________________________________________________

Patient's Attending Physician:
___________________________________________________________

Address:
___________________________________________________________