Cancer Centre support documents

The Cancer Centre of Southeastern Ontario provides treatment and care to cancer patients from across the South East LHIN. We have developed a number of support documents to assist with referrals to cancer related services.

Also included below is support information for primary care physicians and hospital healthcare practitioners to assist support you when patients return to your care.

Referral forms

• New patient referral form

• Abnormal FIT/FOBT Result for Colonoscopy

• Autologous referral form (Stem Cell Transplant Program) PLEASE SEND REFERRAL FORM AND SUPPORTING DOCUMENTS TO MALIGNANT HEMATOLOGY DAY UNIT

• Dermatology - Mohs clinic referral form 

• Family history form 

• General cancer genetics referral form 

• Hereditary breast or ovarian cancer referral form

• Hereditary colorectal cancer  referral form

• South East Colorectal Diagnostic Assessment Program Referral Form (CDAP)

• South East Esophagogastric Diagnostic Assessment Program Referral Form

• South East Lung Diagnostic Assessment Program Referral Form

Requisitions

• Life Labs CEA testing - CARCINOEMBRYONIC ANTIGEN TEST

Well follow-up care

Immune Checkpoint Inhibitor Side Effect Toolkit

• Provider tools

Breast Cancer - Well Follow-up Care

• Breast - Monitoring Plan - Surveillance and Secondary Prevention
• Patient follow-up care after Breast Cancer

Colorectal Cancer (CRC) - Well Follow-up Care

• CRC - Monitoring Plan - Surveillance and Secondary Prevention
• Patient follow-up care after Colorectal Cancer

• Life Labs CEA testing - CARCINOEMBRYONIC ANTIGEN TEST

The Cancer Centre is part of the South East Regional Cancer Program, which is a network of service providers that offer cancer services for residents of Hastings, Prince Edward, Lennox and Addington, Frontenac, Leeds and Grenville counties, Kingston, Belleville, Brockville, Smiths Falls, Prescott, and parts of Lanark and Northumberland counties.