Have you previously had surgery or other treatment (i. e. chemotherapy, radiotherapy) related to your cancer? If so, please describe the procedures below: Have you previously had surgery or other treatment (i. e. chemotherapy, radiotherapy) related to your cancer?
If so, please describe the procedures below: Normal activity level, no evidence of diseaseAble to carry on normal activity; minor signs or symptoms of diseaseAble to carry on normal activity with effort; some signs or symptoms of diseaseCares for self, but unable to carry on normal activity or do active workRequires occasional assistance, but is able to care for most of their own needsRequires considerable assistance and frequent medical careDisabled; requires special care and assistance|.
Normal activity level, no evidence of diseaseAble to carry on normal activity; minor signs or symptoms of diseaseAble to carry on normal activity with effort; some signs or symptoms of diseaseCares for self, but unable to carry on normal activity or do active workRequires occasional assistance, but is able to care for most of their own needsRequires considerable assistance and frequent medical careDisabled; requires special care and assistance|.
General Health Condition: (Please highlight or underline the one that best applies to you) General Health Condition: (Please highlight or underline the one that best applies to you) PANCREAS CANCER STADIUM 4| PANCREAS CANCER STADIUM 4| What is your diagnosis? What is your diagnosis?
Full Name: _AGUS SUSANTO_ Age: 56 Sex: MALE City/Country: TANJUNG PINANG, INDONESIA Email: JUNAEDIGOH@GMAIL. COM Telephone: 081519171161 Fax: __________________ May we call you? If so, when is a convenient time?
ANYTIME,____________________________________ Full Name: _AGUS SUSANTO_ Age: 56 Sex: MALE.City/Country: TANJUNG PINANG, INDONESIA Email: JUNAEDIGOH@GMAIL. COM Telephone: 081519171161 Fax: __________________ May we call you? If so, when is a convenient time? _ANYTIME,____________________________________ Fuda Fuda Hospital Cancer Center Hospital Cancer Center Medical Information Form Medical Information Form Additional Relevant Medical Information: Additional Relevant Medical Information: ON ATTACHMENT ONE FILES OF CT SCAN RESULT AND RADIOLOGICAL INVESTIGATION FORM| ON ATTACHMENT ONE FILES OF CT SCAN RESULT AND RADIOLOGICAL INVESTIGATION FORM.