Cancer Services
  

Back to Cancer Services

Alternative Form option (PDF)

Lung MDT Assessment Form

(Information with red asterisk ( *) must be supplied)

PRESENTING CLINICIAN

REVIEW AT MEETING

* Triage Category – Choose ONE option only

PATIENT PRESENTING SYMPTOMS

Greater or equal to 10%      
Less than 10%     
None     
0      1      2      3      4     
No (Never)
Yes (Current or Ex-smoker)
Yes      No     
Yes      No     
Yes      No     
Yes      No     
Yes      No     

PATHOLOGY AND STAGING

Yes      No     

CLINICAL STAGE

PET STAGE

PATHOLOGICAL STAGE

PFT (% Predicted)

PREVIOUS TREATMENTS FOR LUNG CANCER - CURRENT OR RECURRENT

Yes      No     
Yes      No     

 

NSW Ministry of Health |   SWSLHD on YouTube   SWSLHD on Facebook   SWSLHD on Twitter
Disclaimer | Privacy Statement | Accessibility | Sitemap
© 2018 South Western Sydney Local Health District
Page last updated: 16 November, 2023