Attach_4_Cover Letters

Attachment 4: Cover Letters

Sample Cover Letter for Health Status Questionnaire

(Date)
(Participant Name And Address)
Dear (Participant Name),
We at the PLCO-Central Data Collection Center (CDCC) want to thank you for your continued commitment
to the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). The health information you have
provided us in the past has contributed to the success of this important national study.
Your ongoing participation is very important. Once again, we would like you to provide us with
some valuable information. Please take a few minutes to complete the enclosed Health Status
Questionnaire and return it to us in the envelope provided for your convenience. No postage is required. If
you are unsure of how to best answer the questions or whether you have had a particular exam, please call
your physician’s office or health care provider. Typically, this information can be given to you over the
phone in a matter of minutes.
Please remember, all information you give us will be kept private under the Privacy Act and will
not be disclosed to anyone but the researchers conducting this study, except as otherwise required by law.
Your name or other identifying information will not appear in any report of the study.
If you have any questions about this form, please contact (Name Of Staff Member), (Title), at (Site
Phone Number). Thank you for your time in completing the questionnaire. We look forward to your
prompt reply.
Sincerely,

Barbara O’Brien, MPH
Project Director, PLCO CDCC
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***Please DO NOT bill patient *** (If there is a fee for records)
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«PFirstName» «PLastName»
«PDepartment»
«PClinicName»
«PAddress»
«PCity», «PState» «PZipCode»

RE: «FirstName» «LastName» «Suffix»
Gender: «Gender»
DOB: «Birthdate»

Dear «PSalutation»:
The above named patient is a participant of the Prostate, Lung, Colorectal, and Ovarian (PLCO) extended
follow-up study, a project of the National Cancer Institute (NCI). The Central Data Collection Center (CDCC),
Westat, is responsible under contract to NCI for collecting follow-up data on research participants. Our
records indicate that this patient received care at your facility for the diagnostic workup and/or treatment of
«CANCER(S) ». In order to complete our research, we are requesting copies of the following medical records
for this patient:

RECORD DATES REQUESTED: From «Diagnosis Date» to «+4weeksDD/MM/YYYY»
Admission and Discharge Summary

Consultations to Oncology or Radiation Oncology
(Chemotherapy, Radiation treatment)

Operative Report

Transrectal Ultrasound (TRUS) Report

Biopsy and Surgery Pathology Reports
(For breast cancer include receptor status)
Cancer Staging Form
Documentation of 1st Chemotherapy or
Radiation Treatment Given
Medical Complications from Diagnostic
and/or Staging Procedures (tests)

PSA Blood Test
Colonoscopy, Flexible Sigmoidoscopy (FSG),
Proctoscopy Reports
CA 125 Blood Test
______________________________________

A copy of the signed Authorization for Release of Information is included with this request.
Medical records may be faxed to 1-888-766-7270 or mailed to:
Ellen Martinusen
PLCO-CDCC Westat, Room GA- L60
9274 Gaither Road
Gaithersburg, MD 20877-1420
We thank you for your time and effort involved in complying with our request. If you have any questions or
concerns, please feel free to contact us at 1-888-329-7556.
Sincerely,

Barbara O’Brien, MPH
Project Director, PLCO CDCC