Referral Low Dose CT Chest - National Lung Cancer Screening Program (NLCSP) Australia

Referral Low Dose CT Chest - National Lung Cancer Screening Program (NLCSP) Australia PATIENT DETAILS Name: DOB: Address: Tel: DATE: ELIGIBILITY CRITERIA - all must be (+) (+) aged between 50 and 70 years (+) show no signs or symptoms suggesting lung cancer (+) currently smoke or have quit smoking in the past 10 years (+) have at least a 30 pack-year smoking history^ ^ Pack-year history = average cigarette packs smoked/day x total years smoked. TYPE OF SCREENING (+) (-) Initial scan (-) Routine return 2 yearly scan (-) Interval scan to monitor previous findings - months (1,2,3,6,12) -> PREVIOUS CT CHEST SCANS (Details if applicable) HISTORY OF ANY CANCER (details if yes) ADDITIONAL CLINICAL NOTES/HISTORY (Details if applicable) REFERRING DOCTOR DETAILS Name: Address: Tel: Email: Provider no.: REFERRING DOCTOR SIGNATURE

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The National Lung Cancer Screening Program (NLCSP) is the Australian screening program using low-dose computed tomography (low-dose CT) scans to look for lung cancer in high-risk people without any symptoms. It aims to find lung cancer early and save lives. Screening for eligible people started on 1 July 2025.

Related Items

• Referral Template

External links

• National Lung Cancer Screening Program (NLCSP)