Required Referral Information

 

The following information will be gathered by MD Anderson personnel at the time of referral:

Patient Information

  • Name
  • Address
  • Date of birth
  • Telephone number
  • Diagnosis
  • Date of diagnosis
  • How the diagnosis was made (physical exam, biopsy, other)
  • What treatment the patient has undergone to date
  • When this treatment was administered and completed
  • Current condition
  • Insurance information

Referring Physician Information

  • Name
  • Office address
  • Telephone number
  • Fax number