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Several versions of the lymphoma treatment plan and summary templates are provided below.
Diffuse Large B-Cell Lymphoma Treatment Plan and Summary templates: these forms include a plan component, to be completed prior to chemotherapy treatment, and a summary to be completed following chemotherapy.
Information About Use of Treatment Plan and Summaries
The treatment summary is not intended to be, and should not be considered, a substitute for written or verbal communication, physical examination and history, or review of the complete medical record. Because the treatment summary will summarize parts of your patient’s medical record and treatment plan, it should be treated as confidential and used or disclosed only in accordance with federal and state privacy laws.
No single treatment plan or summary can be appropriate for all patients. Treating oncologists assume responsibility for tailoring the treatment summary to meet individual patient’s needs. Use of the treatment summary is entirely voluntary.
Use of this tool does not imply ASCO’s endorsement of any specific treatment or any product. ASCO is not responsible for any inaccurate or inappropriate use of the treatment summary.