308 lines
10 KiB
Plaintext
308 lines
10 KiB
Plaintext
English French Notes Complete/Exclude
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A Add a new entry
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Select Enter/Edit Facility file Option:
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Enter 'E' to edit an existing FACILITY or 'A' to add a new FACILITY
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NEXT AVAILABLE LOCAL FIN NUMBER IS
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Do you want to add a new entry
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Identifies the facility that referred the patient to the
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reporting facility.
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Identifies the facility to which the patient was referred for
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care after discharge from the reporting facility.
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If you wish to add a new facility, enter either the 7-digit
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(6020009-6953290) or 8-digit (10000000+) assigned COC FIN
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If the new facility does not have an assigned COC FIN number,
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use the next available local FIN number.
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THE NEXT AVAILABLE LOCAL FIN NUMBER IS
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has no Primaries - cannot track Tumor Status
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: DATE DX MISSING for
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NO Tumor Status Followup Created
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DATE DX must precede DATE OF LAST CONTACT OR DEATH
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DATE OF LAST CONTACT OR DEATH must precede DATE@TIME OF DEATH
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Select Patient:
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********* DISPLAY CONTACTS **********
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Select Patient:
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********** ADD/EDIT CONTACTS **********
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Select Action
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Generate Letter...!!
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Complete Follow-up for Successful Contact!!
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**********Following fields have been updated********
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Name..:
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DATA OK
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*********************ENTRY DELETED*************************
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Enter Patient name:
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ONCOLOGY PATIENT INQUIRY
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********** Patient Follow-up Inquiry ***********
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Patient refers to this patient (him/herself)
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To Correct or edit name, edit 'Contact' in CONTACT File
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To CHANGE the name, Change CONTACT NAME above
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************ PRINT FOLLOW-UP LETTER ************
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You need to designate a contact before printing a letter!
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The letter is sent to 'LAST FOLLOW-UP CONTACT'
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You may enter a new contact if you wish:
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Select Patient:
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Contact or Contact Type is not defined
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Specify TYPE Contact letter:
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You may PRINT a hardcopy
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Choose one:
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No primaries for this Patient
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Enter your selection
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Print PCE data attached to this primary?
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Hit Enter to continue
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Print PCE's for a particular site
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Print PCE's AND Abstracts?
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Print PCE Data
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Enter the amount of alcohol consumed per day in whiskey equivalents
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Note-> One whiskey is equivalent to 10.24 grams of alcohol
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- 12 ounces of beer is equivalent to one whiskey
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- 4 ounces of wine is equivalent to one whiskey
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- 1 ounce of vodka, scotch, etc. is equivalent to one whiskey
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Enter the TOTAL amount of Radiation given
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Select from the following list:
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Common morpholgies for topography
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HISTOLOGY (ICD-O-3):
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Punctuation not allowed
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Lowercase text not allowed
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No nodes examined
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97 or more nodes examined
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Nodes examined, # not specified
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Unknown if nodes examined, NA
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90 or more nodes examined
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Node removal as sampling, # unknown
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Node removal as dissection, # unknown
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Nodes surgically removed, # unknown
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Unknown, NA or -, not stated
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All nodes negative
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96 or more nodes positive
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Positive nodes, # not specified
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Unknown if nodes +, NA, not stated
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No radiation administered
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NA, brachytherapy/radioisotopes administered
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Dose unknown/unknown if administered
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Never consumed alcohol
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97 or more drinks per week
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Yes, number of drinks unknown
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Not documented
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Test not administered
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Test administered but results unknown
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Not administered
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Administered, dose not documented
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Test not done
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Test done, results not documented
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Not documented if test performed
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Test not performed
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Test performed, not documented
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No transfusion performed
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Transfusion performed, units not documented
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Not recorded if transfusion done
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Never used tobacco
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No prior gastric resection
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No transfusion
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Transfusion, # of units not documented
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Not recorded if transfusion done
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No transfusion
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No free margins
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NA, no surgery of primary site
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Unknown, not documented
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Go to Date:
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JR.
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SR.
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MD.
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NMN.
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NMI.
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Choose from the following codes:
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0 Not HIV positive
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1 No known risk category
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3 IV drug user
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4 Blood product recipient
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5 Heterosexual transmission
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6 Congenitally acquired
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7 Multiple categories
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8 Other/Unknown risk category
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9 Unknown if HIV positive
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Not HIV positive
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No known risk category
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Homosexual/Bisexual
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IV drug user
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Blood product recipient
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Heterosexual transmission
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Congenitally acquired
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Multiple categories
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Other/Unknown risk category
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Unknown if HIV positive
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Must be at least 3 characters
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Radiation before chemotherapy
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Chemotherapy before radiation
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Chemotherapy before and after radiation
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Radiation and chemotherapy concurrently
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Unknown if radiation and/or chemo given
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NA, no radiation and/or no chemo given
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Sequence unknown
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1 Radiation before chemotherapy
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2 Chemotherapy before radiation
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3 Chemotherapy before and after radiation
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4 Radiation and chemotherapy concurrently
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7 Unknown if radiation and/or chemo given
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8 NA, no radiation and/or no chemo given
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9 Sequence unknown
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No satellite nodules
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96 or more nodules
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Satellite nodules, # unknown
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NA, non-cutaneous melanoma
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No satellite nodules
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96 or more nodules
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Satellite nodules, # unknown
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NA, non-cutaneous melanoma
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Cutaneous melanoma, thickness unk
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Primary site unknown
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Cutaneous melanoma, thickness unk
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Primary site unknown
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Margins free, distance unknown
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NA, surgery not performed
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mm or more
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Margins free, distance unknown
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NA, surgery not performed
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Sentinel Nodes Positive MUST be less than/equal Sentinel Nodes Examined!
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Number of Basins Positive MUST be less than/equal to Basins Detected!
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No nodes were examined
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97 or more nodes examined
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Nodes examined, # not specified
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Unknown if nodes examined, NA
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No nodes examined
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90 or more nodes examined
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No nodes removed, aspiration performed
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Node removal as sampling, # unknown
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Node removal as dissection, # unknown
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Nodes surgically removed, # unknown
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Unknown, NA or -, not stated
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All nodes negative
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96 or more nodes positive
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Positive nodes, # not specified
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Unknown if nodes +, NA, not stated
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or higher
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No PSA test performed
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Test done, results unknown or not reported
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Unknown if test performed
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No, DCIS not present
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Yes, separate tumor
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Yes, mixed histology component
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Yes, separate tumor and mixed histology
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Yes, unk if separate tumor/mixed histology
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NA, reported tumor not invasive DC
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Unknown if DCIS present
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No, DCIS not present
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Yes, separate tumor
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Yes, mixed histology component
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Yes, separate tumor and mixed histology
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Yes, unk if separate tumor/mixed histology
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NA, reported tumor not invasive DC
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Unknown if DCIS present
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0 No, DCIS not present
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1 Yes, separate tumor
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2 Yes, mixed histology component
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3 Yes, separate tumor and mixed histology
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4 Yes, unk if separate tumor/mixed histology
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8 NA, reported tumor not invasive DC
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9 Unknown if DCIS present
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Invasive DC reported, DCIS not present
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NA, invasive DC not reported
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Invasive DC reported, DCIS present, size unknown
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Invasive DC reported, unknown if DCIS present
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Invasive DC reported, DCIS not present
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NA, invasive DC not reported
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Invasive DC reported, DCIS present, size unknown
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Invasive DC reported, unknown if DCIS present
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No radiation given
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Radiation given, dose unknown
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Unknown if radiation given
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No radiation given
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Radiation given, dose unknown
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Unknown if radiation given
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No mass or no tumor found
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Microscopic focus, no size given
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Unknown; not stated; NA
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Melanoma > or = 9.89 mm in depth
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Use code 989 for melanomas > 9.89 mm in depth
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Too many decimal places
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989 mm or larger
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No decimal point allowed
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Entire circumference
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Diffuse; widespread; linitis plastica
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Familial/multiple polyposis
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Diffuse, entire lobe of lung
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Diffuse; widespread; inflam carcinoma
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Code 998 may only be used with the following sites:
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No mass or no tumor found
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Microscopic focus, no size given
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Unknown; not stated; NA
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Melanoma > or = 9.89 mm in depth
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989 mm or larger
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Entire circumference
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Diffuse; widespread; linitis plastica
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Familial/multiple polyposis
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Diffuse, entire lobe of lung
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Diffuse; widespread; inflam carcinoma
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Mucosal melanoma
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Unknown; not recorded; NA
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Mucosal melanoma
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Unknown; not recorded; NA
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Unknown, cannot be determined, not recorded
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Unknown, cannot be determined, not recorded
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No residual tumor
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Size not specified, tumor judged smaller
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Size not specified, tumor judged unchanged
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Size not specified, tumor judged larger
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NA, surgical treatment not administered
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Unknown, tumor not evaluated
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No residual tumor
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Size not specified, tumor judged smaller
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Size not specified, tumor judged unchanged
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Size not specified, tumor judged larger
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NA, surgical treatment not administered
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Unknown, tumor not evaluated
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Test not performed
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Test performed, not documented
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CANCER REGISTRY ABSTRACT
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Print Date:
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Patient Name:
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Home Address:
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Race:
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Ethnicity:
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Date of Birth:
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Age at DX:
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CANCER IDENTIFICATION
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Accession Number:
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Accession Year:
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Sequence Number:
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Date Dx:
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Dx Facility:
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Date of First Contact:
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Class of Case:
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Type of Reporting Source:
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Primary Site Code:
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Text-Primary Site Title:
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Text-Histology Title:
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AFIP Submission:
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Diagnostic Confirmation:
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Referring Facility:
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Transfer Facility:
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Presentation at Cancer Conf:
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Date of Cancer Conference:
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Print Complete Abstract
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Patient Name:
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EXTENT OF DISEASE AT DIAGNOSIS
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Clinical TNM:
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Pathologic TNM:
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Pathologic T:
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Pathologic N:
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Pathologic M:
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Clinical Stage Group:
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Pathologic Stage Group:
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Staged By (Clin):
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Staged By (Path):
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Lymphatic Vessel Invasion (L):
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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#################### #################### ####################
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