A cancer diagnosis starts a new journey – one filled with complex terminology, treatments and emotions.
This guide has been written especially for
you and your family
to help you navigate every step along the way.
This information will help you understand the latest in technology, treatments and research as well as provide you with access to comprehensive education and support. If you have any additional questions, please speak with your health care team.
T his Bo o k Be l o ngs To :
Name:
phone number
Š 2013 Lexington County Health Services District, Inc. (Rev. 7/2013)
Cancer Services Lexington MedicaL CenteR
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lexington Medical center Important Phone Numbers General Information/Main Switchboard.............. (803) 791-2000 Becky’s Place............................................... (803) 791-2440 1-800-756-4453 Breast Cancer Nurse Navigator......................... (803) 791-2521 1-800-635-0858 Cancer Program Manager................................ (803) 936-8050 Financial Counselor....................................... (803) 936-7397 General Cancers Nurse Navigator...................... (803) 791-2289 (803) 791-2617 Medical Day Infusion Center............................ (803) 791-2287 Medical Social Services................................... (803) 791-2430 Outpatient Social Worker................................ (803) 939-8774 Radiation Oncology....................................... (803) 791-2575 Radiology Department................................... (803) 791-2460 Support Group Network................................. (803) 791-2800 Women’s Imaging......................................... (803) 791-2486
© 2013 Lexington County Health Services District, Inc. (Rev. 7/2013)
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Lexington MedicaL Center Cancer Services
personal information Name:
Date:
Birth Date:
Best Contact Number:
Address:
Emergency Contacts
1.
Phone No.
(Name and Number)
2.
Phone No.
Health Care Provider
Phone No.
W h at I k n o w A b o u t M y C a n c e r Type of Cancer:
Date Diagnosed:
Procedure that Determined Diagnosis: Stage of Cancer at Diagnosis:
Date:
Pathological q
Clinical q
Updated Stages of Cancer:
Imm u n i z at i o n R e c o r d (record the date/year of the last dose taken, if known) Tetanus:
Allergic To
Hepatitis Vaccine:
Pneumonia Vaccine:
Describe Reaction
Allergic To
1.
3.
2.
4.
Flu Vaccine:
Describe Reaction
E x a ms , S u r g e r i e s , P r o c e d u r e s , T r e at m e n t s Type of exam, surgery, procedure or treatment (e.g., biopsy, radiation, chemotherapy)
Date
M y H e a lt h C a r e T e a m Primary Physician:
Phone:
Primary Oncologist:
Phone:
Radiation Oncologist:
Phone:
Surgeon:
Phone:
Nurse Navigator:
Phone:
Š 2013 Lexington County Health Services District, Inc. (Rev. 7/2013)
Cancer Services Lexington MedicaL CenteR
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current medications List all medicines you are currently taking. How this form helps you. • Helps you and your family members remember all of your medicines. • May find and prevent concerns by knowing what medicines you are taking. • Provides your doctor(s) and others with a current list of ALL of your medicines. Doctors need to know the herbals, vitamins and overthe-counter medicines you take!
Date
Prescription and over-the-counter medications (examples: aspirin, antacids) and herbals (examples: ginseng, ginkgo). Include medications taken as needed (example: nitroglycerin). 1. A LWAYS KEEP THIS FORM WITH YOU. Take this form to ALL doctor visits, tests and hospital visits. 2. W RITE DOWN ALL CHANGES MADE TO YOUR MEDICINES on this form. If you stop taking a certain medicine, draw a line through it and write the date it was stopped. If needed, ask your doctor, nurse, pharmacist or family member to help you keep it up-to-date.
Name of Medication and Dose
3. W rite down the name of the doctor who told you to take the medicine(s). You may also write down the reason you are taking the medicine (e.g., high blood pressure, high blood sugar, high cholesterol).
Directions: Use patient-friendly directions (Do not use medical abbreviations)
Date Stopped
1 Reason for taking:
Doctor’s Name:
2 Reason for taking:
Doctor’s Name:
3 Reason for taking:
Doctor’s Name:
4 Reason for taking:
Doctor’s Name:
5 Reason for taking:
Doctor’s Name:
6 Reason for taking:
Doctor’s Name:
7 Reason for taking:
Doctor’s Name:
8 Reason for taking:
Doctor’s Name:
9 Reason for taking:
Doctor’s Name:
10 Reason for taking:
Doctor’s Name: © 2013 Lexington County Health Services District, Inc. (Rev. 7/2013)
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Lexington MedicaL Center Cancer Services
Current Medications — Continued Date
Name of Medication and Dose
Directions: Use patient-friendly directions (Do not use medical abbreviations)
Date Stopped
11 Reason for taking:
Doctor’s Name:
12 Reason for taking:
Doctor’s Name:
13 Reason for taking:
Doctor’s Name:
14 Reason for taking:
Doctor’s Name:
15 Reason for taking:
Doctor’s Name:
16 Reason for taking:
Doctor’s Name:
17 Reason for taking:
Doctor’s Name:
18 Reason for taking:
Doctor’s Name:
19 Reason for taking:
Doctor’s Name:
20 Reason for taking:
Doctor’s Name:
21 Reason for taking:
Doctor’s Name:
22 Reason for taking:
Doctor’s Name:
23 Reason for taking:
Doctor’s Name:
24 Reason for taking:
Doctor’s Name:
25 Reason for taking:
Doctor’s Name:
26 Reason for taking:
Doctor’s Name:
27 Reason for taking:
Doctor’s Name:
© 2013 Lexington County Health Services District, Inc. (Rev. 2/2013)
C ancer S er v i ces L e x i n g t o n M e d i c a l C e n t e R
Int roduction
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Current Medications — Continued Date
Name of Medication and Dose
Directions: Use patient-friendly directions (Do not use medical abbreviations)
Date Stopped
28 Reason for taking:
Doctor’s Name:
29 Reason for taking:
Doctor’s Name:
30 Reason for taking:
Doctor’s Name:
31 Reason for taking:
Doctor’s Name:
32 Reason for taking:
Doctor’s Name:
33 Reason for taking:
Doctor’s Name:
34 Reason for taking:
Doctor’s Name:
35 Reason for taking:
Doctor’s Name:
36 Reason for taking:
Doctor’s Name:
37 Reason for taking:
Doctor’s Name:
38 Reason for taking:
Doctor’s Name:
39 Reason for taking:
Doctor’s Name:
40 Reason for taking:
Doctor’s Name:
41 Reason for taking:
Doctor’s Name:
42 Reason for taking:
Doctor’s Name:
43 Reason for taking:
Doctor’s Name:
44 Reason for taking:
Doctor’s Name: © 2013 Lexington County Health Services District, Inc. (Rev. 2/2013)
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Lexington MedicaL Center Cancer Services