The Cancer Insitute at Alexian Brothers Hospital Network

Your Personal Cancer Care Record

There are many people involved in making your experience at The Cancer Institute at Alexian Brothers Hospital Network successful. We hope you get to meet as many of them as possible. As you meet each person throughout your journey, please write his or her name and telephone number in the appropriate sections of this guide. This page has also been provided to you to serve as a record of important dates and events. Please print and fill in as needed.

 

MY PHYSICIAN:

 

MEDICAL ONCOLOGY (Chemotherapy):

 

RADIATION ONCOLOGY:

 

SURGEON:

 

OTHER PHYSICIANS INVOLVED IN MY CARE:

 

MY ONCOLOGY NURSES:

 

MY HOME HEALTH NURSE:

 

MY RADIATION THERAPISTS:

 

MY SOCIAL WORKERS:

 

MY DIETITIAN:

 

MY CHAPLAIN:

 

OTHER TEAM MEMBERS IMPORTANT TO MY CARE:

 

IMPORTANT DATES REGARDING MY TREATMENT

I WAS DIAGNOSED ON: _________________________, 200___

MY CANCER DIAGNOSIS IS:

MY SURGERY WAS ON:

MY CHEMOTHERAPY

BEGAN: _________________________ ENDED: _______________

MY RADIATION TREATMENT

BEGAN: __________________

ENDED: __________________

OTHER IMPORTANT DATES and EVENTS

(such as; hospital stays, chemotherapy schedules, follow-up appointments, MRI results, CAT scan results):