{"id":619,"date":"2017-08-07T09:51:41","date_gmt":"2017-08-07T09:51:41","guid":{"rendered":"https:\/\/www.nhslref.scot.nhs.uk\/?p=619"},"modified":"2017-08-07T09:51:41","modified_gmt":"2017-08-07T09:51:41","slug":"breast-suspicion-of-cancer-template","status":"publish","type":"post","link":"https:\/\/www.nhslref.scot.nhs.uk\/?p=619","title":{"rendered":"Breast, Suspicion of Cancer Template"},"content":{"rendered":"<p>This is a dictation template to provide a reminder of the information required to complete the referral. The <span style=\"color: #ff0000;\">fields\u00a0in red<\/span> are mandatory and must be completed on the referral protocol.<\/p>\n<h4>Presenting Complaint<\/h4>\n<p><strong><span style=\"color: #ff0000;\">Main Presenting Complaint:<\/span><\/strong> [Text &#8211; <em>98 character maximum<\/em>]<\/p>\n<p><strong><span style=\"color: #ff0000;\">Reason for Referral:<\/span><\/strong> [Text]<\/p>\n<p><strong>World Health Organisation Performance Scale<\/strong><br \/>\nUsing the following as a guide, please select the most appropriate answer to describe the patients general health:<\/p>\n<p><em>Options<\/em>:<\/p>\n<ul>\n<li>Asymptomatic<\/li>\n<li>Symptomatic but completely ambulatory<\/li>\n<li>Symptomatic, &lt;50% in bed during the day<\/li>\n<li>Symptomatic, &gt;50% in bed, but not bedbound<\/li>\n<li>Bedbound<\/li>\n<\/ul>\n<p><strong>Date of Onset:<\/strong>\u00a0Date<\/p>\n<p><strong><span style=\"color: #ff0000;\">Priority:<\/span><\/strong>\u00a0Urgent Suspicion of Cancer<\/p>\n<p><strong><span style=\"color: #ff0000;\">Is this a fast track referral of a previous breast cancer:<\/span><\/strong><\/p>\n<ul>\n<li>Yes<\/li>\n<li>No<\/li>\n<\/ul>\n<p><strong><span style=\"color: #ff0000;\">Is there a suspicion of bilateral disease:<\/span><\/strong><\/p>\n<ul>\n<li>Yes<\/li>\n<li>No<\/li>\n<\/ul>\n<p><strong>Will the patient accept any site for treatment:<\/strong><\/p>\n<ul>\n<li>Yes<\/li>\n<li>No<\/li>\n<\/ul>\n<h5><\/h5>\n<h4>Protocol Specific Questions<\/h4>\n<p><strong><span style=\"color: #ff0000;\">HRT History:<\/span><\/strong><\/p>\n<ul>\n<li>Never<\/li>\n<li>Previously<\/li>\n<li>Current<\/li>\n<\/ul>\n<p><strong>Number of years on HRT:<\/strong> [Text]<\/p>\n<p><strong><span style=\"color: #ff0000;\">Menopause Status:<\/span><\/strong><\/p>\n<ul>\n<li>Pre-Menopausal<\/li>\n<li>Menopausal<\/li>\n<li>Post-Menopausal<\/li>\n<li>Male patient or not applicable<\/li>\n<\/ul>\n<p><strong>Last Menstrual Period:<\/strong> [Date]<\/p>\n<p><strong><span style=\"color: #ff0000;\">Is there a family history of breast cancer:<\/span><\/strong><\/p>\n<ul>\n<li>Yes<\/li>\n<li>No<\/li>\n<\/ul>\n<p><strong>If yes to previous question, please give relationship and age at diagnosis:<\/strong> [Text]<\/p>\n<p><strong><span style=\"color: #ff0000;\">Previous Mammograms:<\/span><\/strong> [Text (<em>please provide date and location or N\/A<\/em>)]<\/p>\n<p><strong><span style=\"color: #ff0000;\">Previous Ultrasounds:<\/span><\/strong>\u00a0[Text (<em>please provide date and location or N\/A<\/em>)]<\/p>\n<p><strong>Previous Breast Clinic appointments:<\/strong> [Text (<em>please provide date and location)<\/em>]<\/p>\n<h5><\/h5>\n<h4>Breast Examination<\/h4>\n<h4>Left Breast<\/h4>\n<p><strong><span style=\"color: #ff0000;\">Is there any left breast abnormality present:<\/span><\/strong><\/p>\n<ul>\n<li>Yes<\/li>\n<li>No<\/li>\n<\/ul>\n<p><strong>Left breast abnormality:<\/strong> [Text <span style=\"color: #ff0000;\"><span style=\"color: #000000;\">(<\/span><em>Please accurately describe the location and type of abnormality<\/em><\/span>)]<\/p>\n<p><strong>Left breast degree of suspicion:<\/strong><\/p>\n<ul>\n<li>Uncertain<\/li>\n<li>Probably Benign<\/li>\n<li>Probably Malignant<\/li>\n<\/ul>\n<h4>Right Breast<\/h4>\n<p><strong><span style=\"color: #ff0000;\">Is there any right breast abnormality present:<\/span><\/strong><\/p>\n<ul>\n<li>Yes<\/li>\n<li>No<\/li>\n<\/ul>\n<p><strong>Right\u00a0breast abnormality:<\/strong> [Text <span style=\"color: #000000;\">(<\/span><span style=\"color: #ff0000;\"><em>Please accurately describe the location and type of abnormality<\/em><\/span>)]<\/p>\n<p><strong>Right\u00a0breast degree of suspicion:<\/strong><\/p>\n<ul>\n<li>Uncertain<\/li>\n<li>Probably Benign<\/li>\n<li>Probably Malignant<\/li>\n<\/ul>\n<hr \/>\n<p><a href=\"https:\/\/www.nhslref.scot.nhs.uk\/?page_id=161\">Suspicion of Breast Cancer Guidelines<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>This is a dictation template to provide a reminder of the information required to complete the referral. The fields\u00a0in red are mandatory and must be completed on the referral protocol. Presenting Complaint Main Presenting Complaint: [Text &#8211; 98 character maximum] Reason for Referral: [Text] World Health Organisation Performance Scale Using the following as a guide, [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[89,87],"tags":[33,7,88],"class_list":["post-619","post","type-post","status-publish","format-standard","hentry","category-all-templates","category-cancer-templates","tag-breast","tag-cancer","tag-dt-cancer"],"_links":{"self":[{"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/posts\/619","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=619"}],"version-history":[{"count":1,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/posts\/619\/revisions"}],"predecessor-version":[{"id":620,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=\/wp\/v2\/posts\/619\/revisions\/620"}],"wp:attachment":[{"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=619"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=619"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nhslref.scot.nhs.uk\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=619"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}