Get Ctr & Id # (acr Use Only):

Filling out the CTR & ID # (ACR USE ONLY): form is an essential task for reporting melanoma cases. This guide provides clear and comprehensive instructions on how to complete the form efficiently while ensuring all required information is accurately captured.

Follow the steps to successfully complete the form online.

1. Click 'Get Form' button to access the form and open it in your preferred document editor.
2. Begin the form by providing the Reporting Facility's name, address, and phone number. Ensure this information is current and accurate to facilitate communication.
3. Enter the reporting physician's name and contact information. If the physician is not the patient's attending physician, indicate this.
4. Fill in the patient identification section, including the patient's name (last, first, middle, maiden/aliases), address at diagnosis, current address, social security number, date of birth, and sex.
5. Mark the appropriate race option and indicate if the patient has a history of other cancers. If applicable, provide the type and diagnosis date for any prior cancer.
6. Indicate the patient's usual industry and occupation.
7. Complete the cancer identification section by attaching a copy of the pathology report and providing details on the stage of disease, date of diagnosis, primary site of melanoma, and tumor measurements, as required.
8. If applicable, complete the lateralization, subtype, and clinical diameter of melanoma fields.
9. Fill in details regarding the surgical diagnostic procedure, treatment provided, and status of the tumor post-surgery.
10. Address any follow-up information, including distant involvement at time of diagnosis and current patient status.
11. Review all entries for accuracy and completeness. Once you have finalized your responses, you can save the changes, download, print, or share the form as necessary.

Complete your documents online to ensure efficient processing and reporting.