Your Medical/Personal History
When you are asking questions from someone who knows more than a little about prostate cancer, the person needs a history before they can give you an educated opinion about your disease and treatment. Don't believe anyone who does not want a history - they are shooting from the hip and may well miss the target and your life depends on hitting the target.
For additional information on the importance of your personal and medical history click "here"
The Information Requested
You probably will not be able to fill out all the information on the form so fill out what you can. You should get copies of all reports and other information in your personal file from all of the doctors, clinics, labs, etc. Ask (or demand) a copy of these for your files and keep them in a 3 ring binder.
This form is to show you the information they need (and you need before treatment decisions) to make an intelligent opinion or a treatment decision. In addition if you are going to use "Ask Don" you should fill out this from and advise Don that it has been filled out. Unless you have already had a treatment do not include anything in the "Treatment History". But don't "Ask Don" about your medical condition unless you fill out this form first so he has your history.
Using the Form
You can print out the email you will receive after submitting the form and carry it with you on your doctors appointments. It is especially good when you are visiting a new doctor as it gives the doctor a quick update of your history.
You can also print out a blank form to use when you are trying to get the material together before you type it in the web form. See the "For Your History" page which has the web form and a link to a PDF file.
Although the form is designed for the newly diagnosed (before treatment choice) it can also be used for those who failed their primary treatment and are looking for the next step. Use the complete form (including Treatment History) when you are fighting failure. The information on the form is not saved (due to security reasons) therefore make sure the answers are correct to the best of your ability before you click on "Submit" - or you will have to do the form all over again.
Printing the Form
I have put the form on the following page in order that you can print it from the page without all of the above material or print the PDF file. Also know that you will be shown the information provided in a summary after you click on "Submit" which you can print and then you will receive an email with a copy of the only the fields that you have filled in. Printing the form pages will give you three or more pages (depending on your answers). Printing from the Summary will give you one page (depending on your answers). The email will also be printable from your email program. The PDF file is a 3 pages.
To access the form click on "Form".
Originally posted 08/26/08
Page Reviewed and/or Updated:
September 20, 2008
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Importance of Medical History
Don't Panic Just Gather Info.
How Sick Are You
Questions - Let Us Help
For Your History
Ask Don - Non Medical
