Access to treatment: inquiry

1

Download and fill out the form

"Access to treatment"

2

For the preliminary assessment by the healthcare professionals, please send all documents listed below:

• “Access to treatment" form completed and signed by the patient - downloadable
• Copy of histological examination
• Copy of most recent MRI (magnetic resonance imaging) and/or CT (computed tomography) performed within 3 months (report and images in DICOM format)
• Copy of the most recent report/referral of examination by the referring doctor, with update date within 3 months from the sending date of the request for consultation.

In case of surgery performed within the last 12 months, to be added:

• Copy of the report of last surgery
• Copy of pre-operative MRI (magnetic resonance imaging) and/or CT (computed tomography) scan (report and images in DICOM format)

In case of previously performed radiation treatment, to be added:

• Copy of report of previous radiation treatments

Please send the diagnostic images in DICOM format so that they can be properly read by the medical staff.
It is possible that you are asked for additional documentation based on the examination of the initially requested one. Clinical documentation received in a manner not complying with the above and/or specifically requested will not be considered.

The documents have to be in English, up-to-date (not older than 3 months), essential and informative

3

To ensure the security of data transmission, please send all the required documents by using one of the following methods:

1. Click here to send us directly and quickly your clinical documentation through an encrypted channel
2. by Fax to the following number: +39 0382-078903
3. by courier to the following address:

Fondazione CNAO
Att: International Patients
Via Erminio Borloni, 1
27100 Pavia (PV) - Italy