SEER Training Modules
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:
- Alive
Still in your facility: Yes _______ No _______
If answer is no:
Date Transferred:
_______________________________________________________Transferred to:
_______________________________________________________- Status of Neoplasm
No evidence of cancer _______ With evidence of cancer _______ Cancer status unknown _______ New areas of recurrence and/or metastasis
Site: ______________________________________ - Quality of Survival
Normal activity _______ Symptomatic and ambulatory _______ Ambulatory more than 50%, occasionally needs assistance _______ Ambulatory less than 50%, nursing care needed _______ Bedridden, may require hospitalization _______
- Status of Neoplasm
- Expired
Place:
______________________________________________________Date:
______________________________________________________Cause of Death:
______________________________________________________Autopsy: Yes _______ No _______
Comments:
___________________________________________________________
Patient's Attending Physician:
___________________________________________________________
Address:
___________________________________________________________
