DEATH INQUIRY DOT MATRIX (28)    FOLLOW-UP FORM LETTER (165.1)

|INDENT(5)||NOWRAP|
|LOWERCASE(LAST FOLLOW-UP CONTACT:ZIP CODE)|
 
|NAME|                  |$E(SSN,8,11)|       |DOB||NOWRAP|
|NOBLANKLINE||STREET ADDRESS 1|
|ZIP CODE|
|WRAP|

|ICD-O TOPOGRAPHY LIST|
 
From the Tumor Registrar,
|HOSPITAL NAME|                                            |TODAY|
 
  We recently learned of the death of the person listed above. In 
order that our follow-up may be complete, please provide the   
information below and return to us in the enclosed envelope.
 
           Date of Death:
 
           Place of Death:
 
           Cause of Death:
|HOSPITAL STREET ADDRESS|
 
           Was there an autopsy?
 
  In order to update our tumor registry abstract, please list any
treatment: |LAST(FOLLOW-UP:DATE OF LAST CONTACT OR DEATH)|. 
 
      
 
 
 
|HOSPITAL CITY,ST ZIP|      
  Your assistance in making our tumor registry complete and valuable  
is appreciated.  
 
                                          |Tumor Registrar|
                                          Tumor Registrar
                                          |TR PHONE NUMBER|
 
|LOWERCASE(ONCOLASTNAME(LAST FOLLOW-UP CONTACT))|
|NOBLANKLINE||LOWERCASE(LAST FOLLOW-UP CONTACT:STREET ADDRESS 1)||WRAP|
|NOBLANKLINE||LOWERCASE(LAST FOLLOW-UP CONTACT:STREET ADDRESS 2)|
|NOBLANKLINE||LOWERCASE(LAST FOLLOW-UP CONTACT:STREET ADDRESS 3)||NOWRAP|

This letter is used to inquire to the Bureau of Vital Statistics regarding
the death of a cancer patient.  This will enable the information to be
obtained from a "disinterested" party, rather than going to the next-of-kin.