CONFIDENTIAL |
Name...................................................................... |
Specialty................................................................. |
Hospital.................................................................. |
Who is the lead clinician for your multidisciplinary team?................ |
Who regularly attends your multidisciplinary team meeting? (Please indicate in each box how many individuals from each specialty attend)........... |
Surgeon |
Medical Oncologist |
Clinical Oncologist |
Specialist Breast Care Nurse |
Research Nurse |
General Practitioner |
Clinic Nurse |
Diagnostic Radiologist |
Radiographer |
Pathologist |
Counsellor |
Psychiatrist/Clinical Psychologist |
Chemotherapy nurse |
Ward Nurse |
Other (please specify).................................................... |