WEBMammography Patient History Sheet CLINICAL HISTORY Last Breast Exam: by: Findings: Yes No Baseline mammogram? Location : Date: Yes No Currently menstruating? ... Additional information_____ Lumpectomy CLINICAL FINDINGS Other: Yes No Palpable lump or abnormality? Right Left Found by:: Patient M.D Other ...
WEBI have had a Mammogram in the past Mammogram was performed at _____. Approximate date of most recent mammogram_____. I have been told I’ve had an abnormal mammogram. Other breast problems include _____ PERSONAL BREAST HISTORY: Have you ever had: Breast cancer?
WEBMAMMOGRAPHY PATIENT HISTORY SHEET. Last Name: First Name: Date of Birth: \ \ Home Phone: ( ) Cell Phone: ( ) May we leave a message? ( Y / N ) Physician(s) to who reports will be sent: Reason for Exam: Yearly Exam Follow-Up New Symptom First Mammogram ... Yes No Family history of pancreatic cancer? (Specify) Yes No Have you been treated with ...
WEBBreast Surgical and Treatment History: List any procedures you may have had: result breast biopsy, excision, aspiration, cyst removal, lumpecto my, mastectomy, reduction, breast implants, other. Include date, type, side and result.
Mammograms - NCI - National Cancer Institute
WEBFeb 21, 2023 · Learn what screening and diagnostic mammograms are and how findings, including breast density, are reported. This fact sheet also discusses the benefits and potential harms of screening mammography.
WEBA mammogram is a low-dose x-ray picture of the breast. Why should I have one? Mammograms can help save lives. They are still the best way to screen for breast cancer. They can find breast lumps...
WEBMammography History. Please circle your answers: 1.) Do you or your Dr. feel a new lump in your breast today...........Yes No If yes is it......Right or Left or Both Indicate lump(s) location(s) above on Diagram: Family History of Breast Cancer . (If NO cancer has been in your family leave lines blank)
WEBMAMMOGRAPHY HISTORY SHEET. Note: If there is deodorant or powder on your breast or on your underarms, please wash it off before you have a mammogram. Ask the technologist for help if you need it. NAME:__________________________ DATE OF BIRTH:______________________ AGE:_______ REFERRING M.D.:_____________________________ DATE OF EXAM
WEBTO ALL MAMMOGRAPHY PATIENTS: • I understand that mammograms do not detect all breast cancers, and that they must be combined with periodic physical exam, monthly breast self-exam, and comparison with any prior mammograms.
WEBFamily history of cancer: Aunt, grandmother, cousin – Breast No Yes Ovarian No Yes Mother, sister, daughter - Breast No Yes Ovarian No Yes Risk Factors: Age at 1st menstrual period? _____ How many children have you delivered? _____ No children Your age when 1st child was born? _____