Print This Page     Close Window Consult Request Guidelines for Breast Cancer Survivorship Program     Breast Cancer Survivorship Program 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. Suggested Additional Test/Management Prior to Specialty Visit Breast Cancer Survivorship Program Referral Form 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 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   UM Consulting Physician Breast Cancer Survivorship Program Revised on: 09/09/2010