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patient, test MRN: 12345

Care Plan Printed on: 04/13/2011

DOB: 3/14/1980 (31Y)

Table of Contents Treatment Summary

TM-1

This is a summary of the highlights of cancer treatment and education for this patient. This does not replace detail from the patient’s medical record. This document is current only as of the date of preparation. This summary document does not represent medical advice, nor does it replace medical treatment or medical advice.


patient, test

Care Plan

MRN: 12345

Printed on: 04/13/2011

DOB: 3/14/1980 (31Y)

TM-1

Treatment Summary To support you with your continued medical care, we have created a summary of the cancer treatment provided to you. If you are reviewing a printed copy of the treatment summary, there may have been updates since the document was last printed. If you are reviewing the treatment summary through EQUICARE CS™, the detail represents treatment delivered to date through this institution. This information is provided for information purposes only and may be an incomplete reflection of diagnosis and treatment information. Treatment decisions should not be made based upon this information.

Diagnosis 4 cm solid mass located at the 10 o'clock position with dcis component

Diagnosis Date: 4/3/2011 (31Y); Laterality: Right; Histology: invasive ductal; II-III, nuclear grade II-III; ICD Code: 174.9; Stage T: 2; N: 0; M: 0; Grade/Tumor Size: 2

Surgery right mastectomy with sentinel node biopsy

Date: 04/13/2011; Laterality: Right; Andrew Salner, MD; Institution: Hartford Hospital; Comment: fictitious pt

Chemotherapy Cyclophosphamide

Dose: 1 pound; Dosage Form: iv; Freq: Daily; # Cycles: 4; Start: 04/12/2011; End: 04/16/2011

Hormone Therapy Anastrazole

Dose: 1 teaspoon; Route: PO; Start: 04/11/2011; End: 04/16/2011

Radiation Therapy chest wall

Laterality: Right; Configuration: Tangential Fields; Energy: 12; Planned Fractions: 5; Delivered Dose: 1000x; Start: 04/10/2011; End: 04/15/2011

Comorbidities diabetes

Active?: yes; Managed by: xxx

This is a summary of the highlights of cancer treatment and education for this patient. This does not replace detail from the patient’s medical record. This document is current only as of the date of preparation. This summary document does not represent medical advice, nor does it replace medical treatment or medical advice.


patient, test

Care Plan

MRN: 12345

Printed on: 04/13/2011

DOB: 3/14/1980 (31Y)

TM-2

Relevant Family History Mother

Cancer Diagnosis: breast cancer; Age at Diagnosis: 50; Current Status: Living, without active disease

Allergies pcn

Response: hives

This is a summary of the highlights of cancer treatment and education for this patient. This does not replace detail from the patient’s medical record. This document is current only as of the date of preparation. This summary document does not represent medical advice, nor does it replace medical treatment or medical advice.


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