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Get Gbmc Hereditary Cancer Risk Assessment Program
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How to fill out the GBMC Hereditary Cancer Risk Assessment Program online
Filling out the GBMC hereditary cancer risk assessment program online is a crucial step in recognizing your genetic risks for cancer. This guide will provide clear and detailed instructions to help you complete the form effectively and accurately.
Follow the steps to successfully complete the assessment form.
- Press the ‘Get Form’ button to access the form and open it in your preferred editor.
- Begin with Part A: Basic Information. Fill in your last name, first name, middle initial, maiden name, date of birth, current age, preferred name, gender, and ethnicity. Provide your full street address, city, state, zip code, and telephone numbers for home, work, and cell. Include your email address and employment status.
- In the Employment Information section, indicate if you are employed full-time, part-time, or not employed. Fill in the employer's name, occupation, and employer's address as applicable.
- Next, choose your marital status and specify how you prefer to be contacted. Answer whether you would like us to leave voicemail messages and whom we may contact if you are unavailable.
- Proceed to fill out the Insurance Information section. Provide details on your primary and secondary insurance, including insurance name, policy number, and subscriber's information.
- Complete Part B regarding your cancer history. If applicable, share your cancer diagnosis age, location, and treatment details.
- In Part C, document your medical history, surgical history, known allergies, and lifestyle information, including tobacco and alcohol use.
- For cancer screening, provide regular screening activities, including breast exams, mammograms, colonoscopies, and PSA blood tests in Part D.
- Fill in details about your current medications in Part E, specifying each medication's dose, frequency, reason, and route of administration.
- Finally, complete the family history section. Include details about each biological family member, their cancer history, and ages at diagnosis or death. Be thorough to facilitate accurate assessment.
- Once all sections are complete, review your information for accuracy. Save the document. You can then email, fax, or mail the completed questionnaire back to us, ensuring it is not printed double-sided if mailing.
Complete the GBMC hereditary cancer risk assessment program online today for a personalized evaluation.
The GBMC Hereditary Cancer Risk Assessment Program includes several key components. First, it evaluates your personal medical history and family history of cancer. Next, professionals conduct genetic testing to identify potential hereditary mutations. Finally, the program provides a comprehensive interpretation of the results, along with recommendations tailored specifically to your situation.
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