Transcript Electronic Reporting for Urology Physician Practices

North Carolina Central Cancer Registry
Instructions and
Reporting Requirements
Appendix B
Electronic Reporting
For
Facilities
March 2014
North Carolina Central Cancer Registry
State Center for Health Statistics
Division of Public Health
Department of Health and Human Services
1908 Mail Service Center
Raleigh, NC 27699-1908
http://www.schs.state.nc.us/units/ccr/
Appendix B
Physician Practice
Casefinding Tracking Log
Appendix B: Casefinding Tracking Log
Appendix B: Facility Casefinding Tracking Log
Appendix B: Facility Casefinding Tracking Log
for reporting to the
North Carolina Central Cancer Registry
Medical
Record #
Last
Name
First
Name
Date
of
Birth
ICD-9-CM
Code
Type of
Cancer
(Primary
Site)
Date of
Diagnosis
Date of
First Visit
Last Date
Record
Reviewed
Date
Submitted
to NCCCR
Reason not Submitted to
NCCCR/Other Comments
NC Hospital that Managed
this Tumor
Hospital
Hospital
Name
Visit Date
Appendix B: Casefinding Tracking Log
Appendix B: Facility Casefinding Tracking Log
Instructions for completing the Facility Casefinding Tracking Log
General Instructions:
• Record all cases identified through reports/patient logs included in the casefinding process.
This includes reportable and non-reportable cases.
• If a patient has two or more independent cases of cancer, the patient will need to be entered
multiple times, once for each primary.
• If this tumor for the patient has already been reported, you do not need to enter the
information again on the form.
• You may use the comments section to record additional notes if necessary. You may also
update the "Last Date Record Reviewed.”
If available, enter the patient’s medical record number.
Medical Record #
Enter the patient's last name.
Last Name
Enter the patient's first name.
First Name
Enter the patient's date of birth.
Date of Birth
If available, enter the ICD-9-CM code.
ICD-9-CM Code
Type of Cancer/Primary Enter the site (organ, tissue, etc.) of the body where the tumor
originated.
Site
Enter the date a medical practitioner first stated this patient has a
Date of Diagnosis
reportable cancer or condition.
Enter the date the patient was first seen at this facility with this
Date of First Visit
reportable cancer.
Appendix B: Casefinding Tracking Log
Appendix B: Facility Casefinding Tracking Log - continued
Instructions for completing the Facility Tracking Log - continued
Last Date Patient Record Reviewed
• Enter the last date the patient's record was reviewed. This can be extremely helpful in not
having to re-review information from previous visits.
Date Entered/Submitted to NCCCR
• Enter the date the case report was entered into the New Case Abstract report form and
therefore submitted to the NCCCR.
• Leave blank if the case is not reportable.
• Record “Incomplete” if a final decision has not been made and further information is
needed.
Appendix B: Casefinding Tracking Log
Appendix B: Facility Casefinding Tracking Log - continued
Reason not Submitted to NCCCR / Comments
•
For cases that were determined not to be reportable, enter the reason the case was not
reported to the NCCCR. Examples include: Seen at ____ Hospital. Not a reportable
condition PIN III, Case already reported, Waiting on upcoming visit for final diagnosis, etc.
•
Enter additional information here that will assist the reporter in future casefinding efforts. It
can be especially helpful to document that a final decision cannot be made. For
example, the information in the record was incomplete and additional information from
the physician or information from a future visit is needed.
•
Enter the North Carolina hospital name if it is documented that the patient was seen at
that North Carolina hospital for the management of this cancer. Leave blank if the
patient was not seen at a North Carolina hospital (or it is unknown) for the management
of this cancer. This case needs to be reported.
•
Enter the visit date (inpatient or outpatient) at that hospital for the diagnosis or treatment
of this cancer. Leave blank if the patient was not seen at a NC hospital (or it is unknown)
for the management of this cancer.
Appendix B
Completed