Date: [DATE]
Patient: [Patient Name], [MRN]
Attending Physician: [Physician Name]
Reason for Visit: Follow-up for diffuse large B-cell lymphoma (DLBCL)
History of Present Illness: Summarize the patient’s DLBCL diagnosis, including:
Date of diagnosis
Stage (I-IV) based on Ann Arbor classification
Site(s) of involvement
IPI score (International Prognostic Index)
Prior treatment history (e.g., R-CHOP regimen, CAR-T cell therapy)
Current symptoms (e.g., fatigue, night sweats, weight loss)
Medications: List all current medications relevant to DLBCL treatment and supportive care.
Physical Exam:
General: Assess for signs of B symptoms (fever, night sweats, weight loss) and lymphadenopathy.
Head and Neck: Check for oropharyngeal lesions.
HEENT (Head, Eyes, Ears, Nose, Throat): Look for signs of extranodal involvement.
Abdomen: Palpate for lymphadenopathy or hepatosplenomegaly.
Laboratory: Summarize relevant lab findings, including:
CBC (complete blood count) with differential
LDH (lactate dehydrogenase) level
Renal function tests
Imaging: Summarize any recent imaging results (e.g., PET scan, CT scan):
Evidence of response (reduction in tumor size)
Signs of new or progressive disease
Assessment:
Summarize the current status of the patient’s DLBCL.
State any changes in the patient’s clinical presentation or laboratory/imaging findings.
Mention response to treatment using appropriate terminology (e.g., complete remission, partial remission, progressive disease).
Plan:
Outline the next steps in the patient’s care, including:
Repeat PET/CT scan in [timeframe] to assess response to treatment
Continuation, modification, or completion of current treatment regimen
Consideration of additional therapies for relapsed/refractory disease
Referral to other specialists (infectious disease, palliative care)
Discuss importance of supportive care and monitoring for treatment complications
Prognosis: Briefly discuss the prognosis for DLBCL, considering factors such as stage, IPI score, and response to treatment.
Education:
Document any patient education provided during the visit, such as information about treatment side effects, importance of follow-up, and signs/symptoms of disease progression.
Follow-up:
Schedule the date for the next clinic visit.
Please note: This is a template and should be adapted to fit the specific needs of each patient.
Additional Information:
This template does not include specific details about the patient’s medical history or medications. You should consult the patient’s medical record for this information.
It is important to document the patient’s performance status (e.g., ECOG score) during each visit.
Always refer to current National Comprehensive Cancer Network (NCCN) guidelines for the management of DLBCL.