As part of our initial evaluation, it is very important to understand in depth the patient's situation and his/her diagnoses.
Every patient is different and the clinical outcome of their condition is highly variable. It is of great importance that the data requested hereby is presented as thorough and chronologically accurate as possible. (Include dates)
Every treatment scheme MUST be mentioned (Chemotherapy, radiotherapy, etc...) and described as well. The details of each (Amount of radiation, number of sessions, drugs used, alternative treatments) will give us information of the current situation and may guide the future therapeutic schemes. Radiological studies (CT scan, MRI, PET-CT, etc) and their results should be described as well and needless to say their chronological data should be included. If possible, any previous medical reports should be attached (Images or documents) given their high prognostic and therapeutical significance.
If the patient is under 18 years old or still living with their parents we need full name, age and the occupation of both parents or legal tutor/s. Also we need to know: Was the pregnancy full term?, and were there any complications during the pregnancy? Was the patient hospitalised before? If so, please mention the reason. As regular information we need complete address, phone number of each parent, email addresses and religion.
If the patient is an adult, please skip section 3 and 4 (father and mother information) and fill section 5 (spouse or another relative information)
Thank you for taking the time to complete this information. It will give us the necessary data to design the most complete treatment for the patient.Sincerely,
Please fill in the Information in the next sections.