East and North Hertfordshire CCG
HEAD & NECK SUSPECTED CANCER REFERRAL FORM. Date of GP decision to refer: Click here to enter a date. No. of pages sent: IF CHOOSE & BOOK IS UNAVAILABLE, COMPLETE. FORM AND FAX /EMAIL. TO . THE. REFERRAL TEAM WITHIN 24 HRS. NOTE: This form is NOT for use for patients aged < 16 years. If your patient does not meet . NICE suspected cancer referral ................
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