| [604] | 1 | English French Notes Complete/Exclude
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| 2 | A Add a new entry
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| 3 | Select Enter/Edit Facility file Option:
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| 4 | Enter 'E' to edit an existing FACILITY or 'A' to add a new FACILITY
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| 5 | NEXT AVAILABLE LOCAL FIN NUMBER IS
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| 6 | Do you want to add a new entry
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| 7 | Identifies the facility that referred the patient to the
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| 8 | reporting facility.
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| 9 | Identifies the facility to which the patient was referred for
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| 10 | care after discharge from the reporting facility.
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| 11 | If you wish to add a new facility, enter either the 7-digit
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| 12 | (6020009-6953290) or 8-digit (10000000+) assigned COC FIN
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| 13 | If the new facility does not have an assigned COC FIN number,
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| 14 | use the next available local FIN number.
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| 15 | THE NEXT AVAILABLE LOCAL FIN NUMBER IS
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| 16 | has no Primaries - cannot track Tumor Status
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| 17 | : DATE DX MISSING for
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| 18 | NO Tumor Status Followup Created
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| 19 | DATE DX must precede DATE OF LAST CONTACT OR DEATH
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| 20 | DATE OF LAST CONTACT OR DEATH must precede DATE@TIME OF DEATH
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| 21 | Select Patient:
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| 22 | ********* DISPLAY CONTACTS **********
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| 23 | Select Patient:
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| 24 | ********** ADD/EDIT CONTACTS **********
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| 25 | Select Action
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| 26 | Generate Letter...!!
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| 27 | Complete Follow-up for Successful Contact!!
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| 28 | **********Following fields have been updated********
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| 29 | Name..:
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| 30 | DATA OK
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| 31 | *********************ENTRY DELETED*************************
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| 32 | Enter Patient name:
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| 33 | ONCOLOGY PATIENT INQUIRY
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| 34 | ********** Patient Follow-up Inquiry ***********
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| 35 | Patient refers to this patient (him/herself)
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| 36 | To Correct or edit name, edit 'Contact' in CONTACT File
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| 37 | To CHANGE the name, Change CONTACT NAME above
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| 38 | ************ PRINT FOLLOW-UP LETTER ************
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| 39 | You need to designate a contact before printing a letter!
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| 40 | The letter is sent to 'LAST FOLLOW-UP CONTACT'
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| 41 | You may enter a new contact if you wish:
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| 42 | Select Patient:
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| 43 | Contact or Contact Type is not defined
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| 44 | Specify TYPE Contact letter:
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| 45 | You may PRINT a hardcopy
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| 46 | Choose one:
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| 47 | No primaries for this Patient
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| 48 | Enter your selection
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| 49 | Print PCE data attached to this primary?
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| 50 | Hit Enter to continue
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| 51 | Print PCE's for a particular site
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| 52 | Print PCE's AND Abstracts?
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| 53 | Print PCE Data
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| 54 | Enter the amount of alcohol consumed per day in whiskey equivalents
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| 55 | Note-> One whiskey is equivalent to 10.24 grams of alcohol
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| 56 | - 12 ounces of beer is equivalent to one whiskey
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| 57 | - 4 ounces of wine is equivalent to one whiskey
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| 58 | - 1 ounce of vodka, scotch, etc. is equivalent to one whiskey
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| 59 | Enter the TOTAL amount of Radiation given
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| 60 | Select from the following list:
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| 61 | Common morpholgies for topography
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| 62 | HISTOLOGY (ICD-O-3):
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| 63 | Punctuation not allowed
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| 64 | Lowercase text not allowed
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| 65 | No nodes examined
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| 66 | 97 or more nodes examined
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| 67 | Nodes examined, # not specified
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| 68 | Unknown if nodes examined, NA
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| 69 | 90 or more nodes examined
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| 70 | Node removal as sampling, # unknown
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| 71 | Node removal as dissection, # unknown
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| 72 | Nodes surgically removed, # unknown
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| 73 | Unknown, NA or -, not stated
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| 74 | All nodes negative
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| 75 | 96 or more nodes positive
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| 76 | Positive nodes, # not specified
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| 77 | Unknown if nodes +, NA, not stated
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| 78 | No radiation administered
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| 79 | NA, brachytherapy/radioisotopes administered
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| 80 | Dose unknown/unknown if administered
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| 81 | Never consumed alcohol
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| 82 | 97 or more drinks per week
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| 83 | Yes, number of drinks unknown
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| 84 | Not documented
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| 85 | Test not administered
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| 86 | Test administered but results unknown
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| 87 | Not administered
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| 88 | Administered, dose not documented
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| 89 | Test not done
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| 90 | Test done, results not documented
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| 91 | Not documented if test performed
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| 92 | Test not performed
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| 93 | Test performed, not documented
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| 94 | No transfusion performed
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| 95 | Transfusion performed, units not documented
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| 96 | Not recorded if transfusion done
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| 97 | Never used tobacco
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| 98 | No prior gastric resection
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| 99 | No transfusion
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| 100 | Transfusion, # of units not documented
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| 101 | Not recorded if transfusion done
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| 102 | No transfusion
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| 103 | No free margins
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| 104 | NA, no surgery of primary site
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| 105 | Unknown, not documented
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| 106 | Go to Date:
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| 107 | JR.
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| 108 | SR.
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| 109 | MD.
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| 110 | NMN.
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| 111 | NMI.
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| 112 | Choose from the following codes:
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| 113 | 0 Not HIV positive
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| 114 | 1 No known risk category
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| 115 | 3 IV drug user
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| 116 | 4 Blood product recipient
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| 117 | 5 Heterosexual transmission
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| 118 | 6 Congenitally acquired
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| 119 | 7 Multiple categories
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| 120 | 8 Other/Unknown risk category
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| 121 | 9 Unknown if HIV positive
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| 122 | Not HIV positive
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| 123 | No known risk category
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| 124 | Homosexual/Bisexual
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| 125 | IV drug user
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| 126 | Blood product recipient
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| 127 | Heterosexual transmission
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| 128 | Congenitally acquired
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| 129 | Multiple categories
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| 130 | Other/Unknown risk category
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| 131 | Unknown if HIV positive
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| 132 | Must be at least 3 characters
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| 133 | Radiation before chemotherapy
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| 134 | Chemotherapy before radiation
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| 135 | Chemotherapy before and after radiation
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| 136 | Radiation and chemotherapy concurrently
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| 137 | Unknown if radiation and/or chemo given
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| 138 | NA, no radiation and/or no chemo given
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| 139 | Sequence unknown
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| 140 | 1 Radiation before chemotherapy
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| 141 | 2 Chemotherapy before radiation
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| 142 | 3 Chemotherapy before and after radiation
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| 143 | 4 Radiation and chemotherapy concurrently
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| 144 | 7 Unknown if radiation and/or chemo given
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| 145 | 8 NA, no radiation and/or no chemo given
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| 146 | 9 Sequence unknown
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| 147 | No satellite nodules
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| 148 | 96 or more nodules
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| 149 | Satellite nodules, # unknown
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| 150 | NA, non-cutaneous melanoma
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| 151 | No satellite nodules
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| 152 | 96 or more nodules
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| 153 | Satellite nodules, # unknown
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| 154 | NA, non-cutaneous melanoma
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| 155 | Cutaneous melanoma, thickness unk
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| 156 | Primary site unknown
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| 157 | Cutaneous melanoma, thickness unk
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| 158 | Primary site unknown
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| 159 | Margins free, distance unknown
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| 160 | NA, surgery not performed
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| 161 | mm or more
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| 162 | Margins free, distance unknown
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| 163 | NA, surgery not performed
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| 164 | Sentinel Nodes Positive MUST be less than/equal Sentinel Nodes Examined!
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| 165 | Number of Basins Positive MUST be less than/equal to Basins Detected!
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| 166 | No nodes were examined
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| 167 | 97 or more nodes examined
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| 168 | Nodes examined, # not specified
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| 169 | Unknown if nodes examined, NA
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| 170 | No nodes examined
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| 171 | 90 or more nodes examined
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| 172 | No nodes removed, aspiration performed
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| 173 | Node removal as sampling, # unknown
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| 174 | Node removal as dissection, # unknown
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| 175 | Nodes surgically removed, # unknown
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| 176 | Unknown, NA or -, not stated
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| 177 | All nodes negative
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| 178 | 96 or more nodes positive
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| 179 | Positive nodes, # not specified
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| 180 | Unknown if nodes +, NA, not stated
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| 181 | or higher
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| 182 | No PSA test performed
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| 183 | Test done, results unknown or not reported
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| 184 | Unknown if test performed
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| 185 | No, DCIS not present
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| 186 | Yes, separate tumor
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| 187 | Yes, mixed histology component
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| 188 | Yes, separate tumor and mixed histology
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| 189 | Yes, unk if separate tumor/mixed histology
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| 190 | NA, reported tumor not invasive DC
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| 191 | Unknown if DCIS present
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| 192 | No, DCIS not present
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| 193 | Yes, separate tumor
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| 194 | Yes, mixed histology component
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| 195 | Yes, separate tumor and mixed histology
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| 196 | Yes, unk if separate tumor/mixed histology
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| 197 | NA, reported tumor not invasive DC
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| 198 | Unknown if DCIS present
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| 199 | 0 No, DCIS not present
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| 200 | 1 Yes, separate tumor
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| 201 | 2 Yes, mixed histology component
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| 202 | 3 Yes, separate tumor and mixed histology
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| 203 | 4 Yes, unk if separate tumor/mixed histology
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| 204 | 8 NA, reported tumor not invasive DC
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| 205 | 9 Unknown if DCIS present
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| 206 | Invasive DC reported, DCIS not present
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| 207 | NA, invasive DC not reported
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| 208 | Invasive DC reported, DCIS present, size unknown
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| 209 | Invasive DC reported, unknown if DCIS present
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| 210 | Invasive DC reported, DCIS not present
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| 211 | NA, invasive DC not reported
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| 212 | Invasive DC reported, DCIS present, size unknown
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| 213 | Invasive DC reported, unknown if DCIS present
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| 214 | No radiation given
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| 215 | Radiation given, dose unknown
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| 216 | Unknown if radiation given
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| 217 | No radiation given
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| 218 | Radiation given, dose unknown
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| 219 | Unknown if radiation given
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| 220 | No mass or no tumor found
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| 221 | Microscopic focus, no size given
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| 222 | Unknown; not stated; NA
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| 223 | Melanoma > or = 9.89 mm in depth
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| 224 | Use code 989 for melanomas > 9.89 mm in depth
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| 225 | Too many decimal places
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| 226 | 989 mm or larger
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| 227 | No decimal point allowed
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| 228 | Entire circumference
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| 229 | Diffuse; widespread; linitis plastica
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| 230 | Familial/multiple polyposis
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| 231 | Diffuse, entire lobe of lung
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| 232 | Diffuse; widespread; inflam carcinoma
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| 233 | Code 998 may only be used with the following sites:
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| 234 | No mass or no tumor found
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| 235 | Microscopic focus, no size given
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| 236 | Unknown; not stated; NA
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| 237 | Melanoma > or = 9.89 mm in depth
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| 238 | 989 mm or larger
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| 239 | Entire circumference
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| 240 | Diffuse; widespread; linitis plastica
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| 241 | Familial/multiple polyposis
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| 242 | Diffuse, entire lobe of lung
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| 243 | Diffuse; widespread; inflam carcinoma
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| 244 | Mucosal melanoma
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| 245 | Unknown; not recorded; NA
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| 246 | Mucosal melanoma
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| 247 | Unknown; not recorded; NA
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| 248 | Unknown, cannot be determined, not recorded
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| 249 | Unknown, cannot be determined, not recorded
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| 250 | No residual tumor
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| 251 | Size not specified, tumor judged smaller
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| 252 | Size not specified, tumor judged unchanged
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| 253 | Size not specified, tumor judged larger
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| 254 | NA, surgical treatment not administered
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| 255 | Unknown, tumor not evaluated
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| 256 | No residual tumor
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| 257 | Size not specified, tumor judged smaller
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| 258 | Size not specified, tumor judged unchanged
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| 259 | Size not specified, tumor judged larger
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| 260 | NA, surgical treatment not administered
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| 261 | Unknown, tumor not evaluated
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| 262 | Test not performed
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| 263 | Test performed, not documented
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| 264 | CANCER REGISTRY ABSTRACT
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| 265 | Print Date:
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| 266 | Patient Name:
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| 267 | Home Address:
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| 268 | Race:
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| 269 | Ethnicity:
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| 270 | Date of Birth:
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| 271 | Age at DX:
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| 272 | CANCER IDENTIFICATION
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| 273 | Accession Number:
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| 274 | Accession Year:
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| 275 | Sequence Number:
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| 276 | Date Dx:
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| 277 | Dx Facility:
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| 278 | Date of First Contact:
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| 279 | Class of Case:
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| 280 | Type of Reporting Source:
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| 281 | Primary Site Code:
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| 282 | Text-Primary Site Title:
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| 283 | Text-Histology Title:
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| 284 | AFIP Submission:
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| 285 | Diagnostic Confirmation:
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| 286 | Referring Facility:
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| 287 | Transfer Facility:
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| 288 | Presentation at Cancer Conf:
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| 289 | Date of Cancer Conference:
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| 290 | Print Complete Abstract
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| 291 | Patient Name:
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| 292 | EXTENT OF DISEASE AT DIAGNOSIS
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| 293 | Clinical TNM:
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| 294 | Pathologic TNM:
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| 295 | Pathologic T:
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| 296 | Pathologic N:
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| 297 | Pathologic M:
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| 298 | Clinical Stage Group:
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| 299 | Pathologic Stage Group:
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| 300 | Staged By (Clin):
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| 301 | Staged By (Path):
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| 302 | Lymphatic Vessel Invasion (L):
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| 303 | #################### #################### ####################
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| 304 | #################### #################### ####################
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| 305 | #################### #################### ####################
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| 306 | #################### #################### ####################
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| 307 | #################### #################### ####################
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