Facility/Institution Name TCR Facility ID Number
Type of Facility* Hospital
Ambulatory Surgical Centers
Cancer Treatment Center
Military/Veteran's Health Administration
Are you currently reporting to the Texas Cancer Registry?
Primary Contact Name*
Primary Contact Name*
Position or Title* Phone Number (with area code)* E-mail Address* Alternate Contact Name (if available) Alternate Contact E-mail Address Alternate Contact Phone Number FAX Street Address* City* State* ZIP* Health Service Region Map Health Service Region* Date Training Requested* (Please allow a minimum of four weeks notice)Types of Training:Basic Training (2 days) Available online or in-person.- Introduction to Cancer Reporting and Reporting Tool- Basic Anatomy and Physiology- Medical Terminology- Introduction to Coding, Coding Manuals and Software- CasefindingThis training is intended for:- Reporters who are new to abstracting with no previous experience with cancer data collection- Newly reporting facilities required to submit a full abstract such as full-service hospitals with inexperienced cancer reporters, new registry supervisors.Advanced Training (1-2 days) Available online or in-person. - Refresher course on any of the items from the Basic Training- New reporting requirementsThis training is intended for full-service hospitals only.Specialized Training (1 day) Available online or in-person.- Site-Specific Training - as needed by facility, e.g. specialized dermatopathology training- Hematopoietic & Lymphoid Neoplasm TrainingThis training is intended for new and experienced Reporters from the following centers/facilities:- Ambulatory Surgical Centers- Physician’s OfficesSoftware Training (1 day) Available online or in-person.- Web Plus (Hospital reporters; upload and reports for all reporters including those using commercial vendor software)- eMaRC (Pathology laboratory and physician reporting software)- Acceptable Encryption Methods and Data SubmissionThis training is intended for all Reporters.Type of Training Requested* Basic Training
Number of Attendees* Reason Training Needed* New Reporter
Newly Reporting Facility
Other (please specify in text box below)
Other reason specified Fields denoted with an asterisk (*) are required to submit form.
Internet Policy | HHS Agencies | Homeland Security | Statewide Search | Texas.gov | Privacy Practices