HEMATOLOGY ONCOLOGY FELLOW INPATIENT CONSULT NOTE

HEMATOLOGY ONCOLOGY FELLOW INPATIENT CONSULT NOTE
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Reason for consult:
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HPI: please list diagnosis, stage, prior therapy, current therapy
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Hem/Onc History:
- Date of first abnormal radiology/finding:
- Date of diagnosis
- Pathology: histology, clinical stage, pathologic stage, molecular testing, 
cytogenetics, FISH
- Treatment: surgery, lymph node sampling, radiation, chemotherapy
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PMHX: |VA-WRIISC ACTIVE PROBLEMS|
ALLERGIES: |ALLERGIES/ADR|
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Interval history: *
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ECOG:
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VITAL SIGNS:
BP. = |BP|
P. = |PULS|
T. = |TEMP|
Ht. = |PATIENT HEIGHT|
Wt. = |WT|
BMI = |BODY MASS INDEX|
Pain = |PAIN|
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PHYSICAL EXAMINATION:
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REVIEW OF LABORATORY RESULTS ON /**/23: Reviewed
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IMAGE RESULTS: reviewed
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PATHOLOGY: reviewed
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Assessment and plan:
- Please include diagnosis and stage
- Treatment, dose, how many cycles planned
- Imaging next due
Case discussed with
[For phone visits, please list minutes] Time spent:
Treatment Summary
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ACTIVE TREATMENT SUMMARY 
1. Diagnosis: current staging (TNM or if localized to metastatic include date 
of 
PD) 
2. Treatment: what line of treatment, name of treatment, dosing, schedule (ie 
q3wks), (treatment date initiation - expected end date and if no end date then 
write until progression)
3. Recent Dose Reductions in Treatment: yes/no and list latest dose reduction 
or 
change in therapy 
4. Adverse Events from Treatment: yes/no and list AE
5. ECOG: 
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Anticoagulation Summary
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ANTICOAGULATION RECOMMENDATIONS SUMMARY
1. Reason for Anticoagulation?: VTE (date of diagnosis of VTE) 
2. Provoked or Unprovoked VTE?: 
3. Anticoagulation type, dosing, duration: 
4. Is patient is eligible for DOAC prophylaxis dosing in the future? Yes/No
5. Hypercoagulable work up indicated?: Yes/No
6. Can patient interrupt anticoagulation for a procedure: Yes/No
7. Does patient require bridging of therapy?: Yes/No (consult hem/onc?)
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