Download Multiple Myeloma Referral - Virginia Cancer Specialists

Survey
yes no Was this document useful for you?
   Thank you for your participation!

* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project

page
1
page
2
Document related concepts
no text concepts found
Transcript 
Fax
To:
Fax:
Fairfax Stem Cell Transplant From:
Pages:
703-208-9284
Phone: 703-208-9202
Date:
Re:
CC:
Records for New Patient
Consult
Urgent
For Review
Please Comment
Please Reply
Please Recycle
Comments:
The documents and information contained in the facsimile are confidential material and may be legally privileged. The materials
are intended only for the use of the individuals or entity addressed. If you are not the intended recipient, do not use or disclose
this facsimile. If you have received this facsimile in error please immediately notify us by telephone same.
Patient:
DOB:
Consult Date:
REQUIRED RECORDS FOR NEW PATIENT REFERRAL: MULTIPLE MYELOMA
MD PROGRESS NOTES:
Initial Consultation with Oncologist
Most Recent Progress Note
PATHOLOGY REPORTS--AT DIAGNOSIS AND MOST RECENT:
Bone Marrow Biopsy and Aspirate Reports
include any special studies performed: flow cytometry, cytogenetics, FISH
Other Biopsy Reports, if applicable
such as biopsy of bone, biopsy of plasmacytoma mass
LABS AT DIAGNOSIS AND MOST RECENT:
CBC
Chemistry panel, LDH
Immunoglobulin panel (IgG, IgA, IgM)
Beta-2 microglobulin
C-Reactive Protein, if available
SPEP (serum protein electrophoresis), SIEP (serum immunoelectrophoresis) and/or Immunofixation
Urine for TP (total protein)
UPEP (urine protein electrophoresis), UIPEP (urine immunoelectrophoresis) and/or Immunofixation
RADIOLOGY AND NUCLEAR MEDICINE REPORTS AT DIAGNOSIS AND MOST RECENT:
Skeletal Survey
Bonescan
MUGA Scan
TREATMENT RECORDS / FLOWSHEETS
For all chemotherapy cycles (oral/IV) or other injections/infusions
(such as Thalidomide, Revlimid, Velcade, Zometa)
Radiation Therapy records, if applicable
The documents and information contained in the facsimile are confidential material and may be legally privileged. The materials
are intended only for the use of the individuals or entity addressed. If you are not the intended recipient, do not use or disclose
this facsimile. If you have received this facsimile in error please immediately notify us by telephone same.
Related documents