Late Effects Survey submitted by Laura Wieber for M D Anderson Cancer Center- Orlando

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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: (4)Other criteria- up to the age of 21 or 10 years off therapy which ever comes later.
*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:321-841-8588
General information: Answer:321-841-8588
New LFTU patient referrals: Answer:321-841-8588
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: (2)Primary adult healthcare provider (family practitioner/internist/NP/PA/gynecologist)
If your institution has a specialized long-term follow-up program for childhood cancer survivors, please complete the following information:
5. Program name: Answer:Follow Up After Cancer Treatment (FACT)
6. Program director: Not Answered
7a. Program coordinator: Answer:Laura Wieber, MSN, ARNP, FNP-BC
7b. Program coordinator:  Not Answered
*8. What are the eligibility criteria for survivors entering your program?
Answer: 2 years off therapy
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
Family/Adult Nurse Practitioner
Physician's assistant
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