| MAIN FORM BODY |
|INDENT(5)||NOWRAP|
|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|
|LOWERCASE(LAST FOLLOW-UP CONTACT:ZIP CODE)|
|NAME| |$E(SSN,8,11)| |DOB||NOWRAP|
|NOBLANKLINE||STREET ADDRESS 1|
|ZIP CODE|
|WRAP|
|TODAY|
|ICD-O TOPOGRAPHY LIST|
From the Tumor Registrar,
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:
Was there an autopsy?
In order to update our tumor registry abstract, please list any
treatments since |LAST(FOLLOW-UP:DATE OF LAST CONTACT OR DEATH)|.
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))|
|
