UNIFIED INSURANCE NETWORK

In the event medical records need to be ordered please provide Doctor(s) name, address, phone number, and date last seen... Date of diagnosis Type of cancer? (Bladder, Breast, Cervical, Kidney, etc) Location Type Tumor size Stage Grade What treatment was used? Surgery, Chemotherapy, radiation, other? When did treatment begin and end? Please provide dates. What type of medications were used? Please provide details and dates. If testing has been done since the last treatment, please provide type of testing and results. Please provide details and dates. Are regular follow-ups completed with a primary care physician or oncologist? Please provide details and dates. Was there any recurrence? Please provide details and dates. Did the cancer matastasize? Please provide details and dates... Have you had a heart attack(s)? Please provide details and dates. Have you had bypass surgery? Please provide details (number of vessels) and dates. Have you had an angioplasty(ies)? Please provide details..