To submit a patient case for consideration, please complete the following questionnaire. If you are submitting more than one case, please complete a separate questionnaire for each case. The deadline for submitting cases is Monday, July 8, 2019.

Please answer the questions with as much detailed information as possible. Complete answers will assist us with the case selection process.

Cases will be evaluated and selected by the Congress organizers. Selected case studies will be presented during the panel discussions at the Congress, featured on the Congress app, and published on the NCCN Continuing Education Portal (education.nccn.org) after the Congress.

Note: The cases will be presented by Congress faculty with discussion by a panel of experts from NCCN Member Institutions and the practice community. All faculty for the Congress have been confirmed. Case study submitters will be recognized in the congress materials, including the in-room slides, and verbally by the Congress Co-Chairs prior to each panel discussion.

Submission Guidelines: There is no fee associated with submitting a case study, and you do not need to be registered for the Congress to submit a case. You may submit more than one case for consideration, and you may be asked to complete and submit an NCCN Continuing Education Conflicts of Interest Form to disclose any relevant financial relationships.

 

Disease Subtype
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Patient Demographics & History
Please provide the following information about the patient:
Please summarize with bullet points.
Please summarize with bullet points.
Patient Treatment Overview
Please provide the following clinical information with relative/approximate dates:
Please summarize with bullet points.
Please summarize with bullet points.
Please summarize with bullet points.
Please summarize with bullet points.
Please summarize with bullet points.
Panel Discussion Questions
Supplemental Files
Click "Choose a File," select the file, and click "Upload."
Files must be less than 6 MB.
Allowed file types: gif jpg jpeg png pdf doc ppt pptx.
Click "Choose a File," select the file, and click "Upload."
Files must be less than 6 MB.
Allowed file types: gif jpg jpeg png pdf doc ppt pptx.
Click "Choose a File," select the file, and click "Upload."
Files must be less than 6 MB.
Allowed file types: gif jpg jpeg png pdf doc ppt pptx.
Click "Choose a File," select the file, and click "Upload."
Files must be less than 6 MB.
Allowed file types: gif jpg jpeg png pdf doc ppt pptx.
Contact Information
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*
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