| *1. How does your institution provide
follow-up care for childhood cancer survivors?
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Answer:(1)Followed in regular ONCOLOGY CLINIC by pediatric oncology healthcare provider (MD/NP/PA)
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| *2. What is the age cut-off for providing
follow-up care to childhood cancer survivors at your institution?
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Answer:
(1)No age limitation - followed for life
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*3. Please provide phone numbers (as
applicable) for referral of long term follow-up patients to your Institution.
(If not available, enter "None"):
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| Appointments: |
Answer:216-444-3608
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| General information: |
Answer:216-444-0015
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| New LFTU patient referrals: |
Answer:216-444-3608
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| Comments: |
Answer:Ask for Holly Kubaney, NP
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| *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:
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Answer:
(4)Other-Patients are seen in Pediatric Clinic unless patient choose to be transferred to adult service.
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| If your institution has a specialized long-term follow-up program for
childhood cancer survivors, please complete the following information: |
| 5. Program name: |
Answer:High Five Clinic
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| 6. Program director: |
Answer:Gregory Plautz, MD
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| 7a. Program coordinator: |
Answer:Holly Kubaney, NP
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| 7b. Program coordinator: |
Answer:Sally Muehle, CCRP
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| *8. What are the eligibility criteria for survivors
entering your program?
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| Answer: |
2 years off therapy
Bone marrow transplant patients are eligible
Neuro-oncology patients are eligible
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| *9. Do you offer late effects
consultations to survivors who were not treated at your institution?
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Answer:
Yes
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*10. What information is required for
a patient being referred from an outside facility to your program?
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| Answer: |
Health care provider referral letter
Medical Records
Patient may self-refer into the program
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| 11. If your institution has a specialized adult follow-up program,
please provide the following information:
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| Program name:
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Not Answered
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| Program director:
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Not Answered
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| Program coordinator:
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Not Answered
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*12. Who provides the long-term follow-up
care for your adult survivors of childhood cancer?
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| Answer: |
Pediatric Oncologist
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