Department of State Health Services Confidential Cancer Reporting - dshs state tx 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Date of Admit/First Contact' in the specified format (YYYYMMDD). This is crucial for tracking patient history.
3. Fill in the 'Registry Number' and 'Reporting Facility Number' to identify the source of the report accurately.
4. Complete personal information fields such as 'Last Name', 'First Name', 'Middle Name', and 'Maiden Name'. Ensure all names are spelled correctly for accurate identification.
5. Provide the patient's address, including 'Street Address', 'City', 'State', and 'ZIP Code'. This information is essential for demographic data collection.
6. Continue filling out medical details, including 'Date of Birth', 'Sex', and race-related fields. These sections help in understanding cancer trends across different demographics.
7. Document treatment details under sections like 'Date Chemotherapy Started' and other treatment modalities. Accurate entries here are vital for comprehensive cancer care reporting.

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