Please choose all that apply regarding the patient’s self-described identity
Additional Information
American Indian would be in the category “Indigenous American or Alaska Native”. If patient is Indian/from India, choose “Asian Indian”. If it is documented that patient declined to answer, choose “Unknown”.
Looking for help with something we haven’t covered here? Send us a message!
Language of Care
Additional Information
Looking for help with something we haven’t covered here? Send us a message!
Height
Choose the height recorded closest to 1ST chemotherapy date. If no chemotherapy was given, choose the height recorded at the office visit closest to the diagnosis date.
Additional Information
BMI and BSA will auto populate when height and weight is entered
Looking for help with something we haven’t covered here? Send us a message!
Weight
Choose the weight recorded closest to 1ST chemotherapy date. If no chemotherapy was given, choose the height recorded at the office visit closest to the diagnosis date.
Additional Information
BMI and BSA will auto populate when height and weight is entered
Looking for help with something we haven’t covered here? Send us a message!
