Letter of Diagnosis 2025

1. Click ‘Get Form’ to open the Letter of Diagnosis in the editor.
2. Begin by entering the Client Name and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. In the CLIENT CONSENT TO RELEASE INFORMATION section, provide your signature and date to authorize your medical provider to release necessary information.
4. For PROVIDER VERIFICATION, fill in the Type of cancer and Diagnosis date. Select the Clinical Stage from the options provided.
5. Document the Date of most recent surgery by specifying both Month and Year. Then, indicate Current Treatment by checking all applicable boxes.
6. Complete the Oncologist and Medical Facility fields with relevant details. Finally, ensure that a qualified provider signs and dates at the bottom, including their printed name and contact information.

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