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Instructions for patients being referred

If you have been referred, your physician has determined
that you need additional evaluation to determine whether your findings or
symptoms might represent a malignancy.


Unless you have already received the Alliance New Patient Form
from the physician’s office you are referred to, please download and complete
this form prior to your initial visit. All providers in the LCPOE will be using
your completed form, so that you need only complete the form the first time.

Your consulting physicians will need to review
any tests, procedures, or treatments that you have had. Your referring
physician typically will forward the important aspects of your information, but
it is important that you provide as much information as possible , so that we
can expedite your evaluation.

Notes on completion of the Alliance New Patient Form


If you have already had a tissue
biopsy related to your current condition, please complete the pertinent
sections so that your consulting physician can obtain these results prior to
your first visit.


These are tests taken to produce images of the
lungs or other parts of the body. Examples include x-rays, CT scans, MRIs, PET
scans, and bone scans. If these test we done in the area , it may not be
necessary for you to bring disk or film. 
Most hospitals and imaging center participate in a common exchange for
these imaging tests , so that it is enough to complete the location and
approximant date of the imaging tests. To see if imaging center participates
please go to centers in exchange.

Medical Summary:

This is a description written by your doctor
detailing your medical problems and the treatment you have received. Your
physician will forward this when you are referred, but it is helpful for you to
bring a copy.

Your Medication:

Please be sure to bring the bottles of all
medications you take, including those prescribed by doctors and those you buy
over the counter. This should include bottles of any vitamins or herbal
products you take. If you bring a list of medications instead , please include the
name of each medicine, the dose you take, and how often you take it.

Insurance and Prescription Cards:

Please bring the following cards with you to your first appointment:

Your insurance card. 

If you are covered by
more than one insurer, please bring both cards.

Your prescription
coverage or “pharmacy” card.

Your photo ID.

Other Ways to Prepare for Your Appointment Include:

Writing down any questions you may think of before your first visit. Bring these with

Review the information links on our website.

Arranging for a friend or family member to come with you. You will receive a lot of
information that day. It is helpful to have someone else with you to listen and take notes.