Lung Cancer Screening Resource Guide

Appendix of Forms

In addition to providing radiomic informed software solutions, HealthMyne is dedicated to offering resources for lung navigators and others in the organization involved in lung cancer screening. Working in conjunction with Hilary Deskins we have crafted a Lung Cancer Screening Resource Guide to provide practical tools and offer insights based on years of nurse navigator experience in lung cancer screening. The ultimate goal is to help navigators build, expand and improve their programs in order to screen more patients at risk.

Hilary’s years of cancer screening experience and expertise are captured in our guide. Hilary is now a Clinical Application Consultant at HealthMyne and she is available to assist with program consulting and implementing best practices in lung cancer screening.

Appendix Of Forms

The below forms are for example only. HealthMyne does not endorse these forms, but provides them as a guide for you to set them up for your own program.

Click on a form below to download an editable word doc of that form.

1-CTLS Algorithm

2-Criteria CTLS Patients


4-Risk Benefits

5-Pt Requesting CTLS

6-Annual CTLS Due

7-Incomplete Order

8-Order Incorrect

9-Ordered CTLS Not Done

10-Prior Auth Needed

11-Results to Provider Cover Sheet

12-Results Form to Provider

13-Provider Invite to Tumor Board

14-Tumor Board Recommendation

15-Pt Due for Diag FU Exam

16-Request for Diag FU Results

LungRADS Assess Categories Version 1.1

All Lung Cancer Screening Forms