| CONSULT REQUEST GUIDELINES
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Breast Cancer Survivorship Program
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| Suggested Pre-Referral Evaluation and Management Guidelines |
Visits to the Breast Cancer Survivorship Program are scheduled once a patient has completed multimodality treatment and her oncology physician determines a referral to the clinic would be appropriate.
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| Suggested Additional Test/Management Prior to Specialty Visit |
Breast Cancer Survivorship Program Referral Form
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| Patient Education/Information (includes preps) |
Visit types:
One Time Visit: For women <10 years from their breast cancer diagnosis this is a one- time visit that entails a physical exam, annual mammogram, discussion regarding survivorship issues and review of Treatment Summary and Care Plan. Follow up care is assumed by their Primary Care Provider.
Transition Visit: This is a one-time visit to review Treatment Summary and Care Plan and discuss survivorship issues. Follow up care is continued by treating oncology team.
Transfer of Care: For women 2-5 or more years from their breast cancer diagnosis, this visit entails physical exam and mammogram, discussion regarding survivorship issues and review of Treatment Summary and Care Plan. This is a transfer of follow up care to the Breast Cancer Survivorship Clinic where she will be seen annually.
Breast Cancer Survivor's Brochure |
| Appointment Timeframe |
Annually
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| How to Get Results to Consultant |
UMHS Patients: See CareWeb
External Patients: |
| Clinic Contact Information |
Physicians: 800-962-3555
Patients: 734-936-6000 |
| Clinic Location Sites |
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| UM Consulting Physician |
Breast Cancer Survivorship Program
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| Revised on: |
09/09/2010 |
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