10- 144 C.M.R. ch. 255, § 3
Patient data should only be sent to the State Registry for all reportable cancer cases and shall be submitted on materials described in section 5 (B). The following information shall be submitted by reporting facilities and reporting physicians to the Department to identify cancer patients, the type of cancer the patient has, and the facility where the patient was diagnosed:
Reporting Facility/Physician
Sequence Number
Patient's Last Name (including Maiden Name)
Patient's First Name and Middle Initial
Birthdate
Address at Diagnosis; including
City or Town of Residence
County of Residence
State of Residence and Zip Code
Sex
Race
Attending Physician
Referring Physician
Date of Diagnosis
Topography of Cancer (ICD-O Second Edition)
Morphology of Cancer (ICD-O Second Edition)
Usual Occupation
Usual Industry
Social Security Number
Stage of Disease at Diagnosis (most current AJCC coding system)
Patient's Mailing Address
Date of Admission
Laterality
Grade
Spanish/Hispanic Origin
Diagnostic Confirmation
Summary Stage
Date of First Course of Treatment (when available in the medical record)
Type of First Course of Treatment (when available in the medical record)
Supporting Text Fields
10- 144 C.M.R. ch. 255, § 3