SEER Training Modules
11/27/12 - The NCI is working on updating materials.
Sample Follow-up Letter #1
Letter to Physicians
To: James Smith, M.D.
123 Any Street
Anytown, XX 9999
Date of letter: 1/1/02
Last follow-up date:
Other hospital #
From: John Doe, MD
Chair, Cancer Committee
Re: Doe, Jane Mary
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:
- Alive
Date last seen or contacted:
___________________________________________________________- 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 _______ - 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:
______________________________________________________
- Status of Neoplasm
- Expired
Place:
___________________________________________________________Date:
___________________________________________________________Cause of Death:
___________________________________________________________Autopsy: Yes _______ No _______
