| *1. How does your institution provide
follow-up care for childhood cancer survivors?
|
Answer:(1)Followed in regular ONCOLOGY CLINIC by pediatric oncology healthcare provider (MD/NP/PA)
|
| |
| *2. What is the age cut-off for providing
follow-up care to childhood cancer survivors at your institution?
|
Answer:
(1)No age limitation - followed for life
|
| |
*3. Please provide phone numbers (as
applicable) for referral of long term follow-up patients to your Institution.
(If not available, enter "None"):
|
| Appointments: |
Answer:313-966-0660
|
| General information: |
Answer:313-745-5515
|
| New LFTU patient referrals: |
Not Answered
|
| Comments: |
Answer:313-745-1588
|
|
| |
| *4. If your institution does not provide life-long
follow-up care for childhood cancer survivors, please describe where the
patient is referred for long term follow-up when age limitation is reached:
|
Answer:
(1)Adult oncologist
|
| |
| If your institution has a specialized long-term follow-up program for
childhood cancer survivors, please complete the following information: |
| 5. Program name: |
Answer:Late Effects Cancer Survival
|
| 6. Program director: |
Answer:Dr. Yaddanapudi Ravindranath
|
| 7a. Program coordinator: |
Answer:Cathy Patty-Resk
|
| 7b. Program coordinator: |
Not Answered
|
|
| |
| *8. What are the eligibility criteria for survivors
entering your program?
|
| Answer: |
2 years off therapy
Bone marrow transplant patients are eligible
Neuro-oncology patients are eligible
|
|
| |
| *9. Do you offer late effects
consultations to survivors who were not treated at your institution?
|
Answer:
Yes
|
| |
*10. What information is required for
a patient being referred from an outside facility to your program?
|
| Answer: |
Health care provider referral letter
Medical Records
Insurance information
Patient may self-refer into the program
|
|
| 11. If your institution has a specialized adult follow-up program,
please provide the following information:
|
| Program name:
|
Not Answered
|
| Program director:
|
Not Answered
|
| Program coordinator:
|
Not Answered
|
|
| |
*12. Who provides the long-term follow-up
care for your adult survivors of childhood cancer?
|
| Answer: |
Pediatric Oncologist
Family Practice physician
Internal medicine physician
Gynecologist
Pediatric Nurse Practitioner
Other
Adult Oncologist as necessary.
|
|
