Late Effects Survey submitted by April Peterson for University of Alabama

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*1. How does your institution provide follow-up care for childhood cancer survivors?
Answer:(2)Followed in SPECIALIZED PROGRAM for survivors of childhood cancer
 
*2. What is the age cut-off for providing follow-up care to childhood cancer survivors at your institution?
Answer: (1)No age limitation - followed for life
 
*3. Please provide phone numbers (as applicable) for referral of long term follow-up patients to your Institution.
(If not available, enter "None"):
Appointments: Answer:205-939-9285
General information: Answer:205-939-9285
New LFTU patient referrals: Answer:205-939-9285
Comments: Not Answered
 
*4. If your institution does not provide life-long follow-up care for childhood cancer survivors, please describe where the patient is referred for long term follow-up when age limitation is reached:
Answer: (1)Adult oncologist
 
If your institution has a specialized long-term follow-up program for childhood cancer survivors, please complete the following information:
5. Program name: Answer:Taking On Life After Cancer (TLC Clinic)
6. Program director: Answer:Avi Madan-Swain, Jane Sande, Kimberly Whelan, H. Latif
7a. Program coordinator: Answer:Jodelle Carlee
7b. Program coordinator:  Answer:April Peterson
 
*8. What are the eligibility criteria for survivors entering your program?
Answer: 2 years off therapy
5 years from diagnosis
Bone marrow transplant patients are eligible
Neuro-oncology patients are eligible
 
*9. Do you offer late effects consultations to survivors who were not treated at your institution?
Answer: Yes
 
*10. What information is required for a patient being referred from an outside facility to your program?
Answer: Medical Records
Insurance information
Patient may self-refer into the program

11. If your institution has a specialized adult follow-up program, please provide the following information:
Program name: Not Answered
Program director: Not Answered
Program coordinator: Not Answered
 
*12. Who provides the long-term follow-up care for your adult survivors of childhood cancer?
Answer: Pediatric Oncologist
Pediatric Nurse Practitioner
Other
Clinical Nurse Specialist
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