Professional Documents
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071231
Department of Medical Oncology P 080121
DIAGNOSIS: Anaplastic Date Wgt Name:
Oligodendroglioma Hgt (cm): _____ MRN:
STAGE: Address:
REGIMEN:
Wgt (kg): _____
Avastin
BSA:_______m2 DOB:
No. of cycles; Length of Cycle: 2
weekly Date: 07/12/2021
Gender: M / F
Dr’s signature
(to proceed)
Pharmacist
Dose admin.
Given by
100% dose = (mg)
Checked by
Signature: Date:
Protocol modifications as per: http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/default.htm
Anti-emetic guidelines as per: http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/SupportiveCare/default.htm
Medical Oncologist: Beaumont Hospital / Cancer Centre BH V. 071231
Department of Medical Oncology P 080121
DIAGNOSIS: COLON CANCER Date Wgt Name:
STAGE: Hgt (cm): _____ MRN:
Address:
REGIMEN:
Avastin
Wgt (kg): _____
Pharmacist
Dose admin.
Given by
Checked by
100% dose = (mg)
Signature: Date:
Protocol modifications as per: http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/default.htm
Anti-emetic guidelines as per: http://www.bccancer.bc.ca/HPI/ChemotherapyProtocols/SupportiveCare/default.htm