Patient Forms
- New Patient Forms Packet (2/2021)
- Established Patient Forms Packet (10/2020)
- Telemedicine Patient Instructions (5/2020)
- Financial Assistance Application Packet (1/2021)
- Patient Acknowledgement & Consent for Health Information Disclosure, Education, treatment, and Billing (3/2020)
- Patient Approved List of Contacts (1/2020)
- Patient Authorization for Electronic Health Records (UOC) (9/2013)
- Dietary Supplements List
- Patient History Questionnaire (3/2020)
- Patient Self-Assessment
- Symptom Assessment
- Patient Notice of Privacy Practices (5/2017)
- Patient Satisfaction Survey
For assistance with Patient Forms contact:
CCC Finance Department
Echo Peel | Phone: 541-673-2267
or Email: Echo@CCCRoseburg.org
Patient Liaison
A cancer diagnosis elicits many emotions, including fear, sadness and confusion. It is easy to become overwhelmed. CCC’s Patient Liaison program is here to help.
A Patient Liaison provides individualized assistance to you and your family and helps you overcome healthcare system barriers and access quality medical and psycho-social care. Patient Liaisons work with you from diagnosis through all phases of the cancer experience and can help with a wide range of support, including smoking cessations, genetic testing, counseling, financial resources, transportation, nutritional needs, palliative care/hospice, general information, housing and legal issues.
For more information about our Patient Liaison program contact:
CCC Nursing Department
Ashley Ortiz NCMA | Patient Liaison | Phone: 541-673-2267
or Email: AOrtiz@cccroseburg.com
Patient Education Videos
Insurance
The Community Cancer Center accepts many different insurers, including, but not limited to, Blue Cross/Blue Shield of Oregon, Medicare, LifeWise, PacificSource, and ODS Health Plan.
Regardless of your exact situation, our financial counselor will work with you to develop a payment plan that’s right for your needs.
For more information about billing and insurance contact:
CCC Finance Department
Echo Peel | Phone: 541-673-2267
or Email: Echo@CCCRoseburg.org
Medical Nutrition Therapy
Ensuring patients get the nutrients they need to maintain their lean body mass and strength helps keep body tissue healthy to fight infection. During treatment, the overall goal of nutritional therapy is to minimize nutrition-related side effects and maximize quality of life.
Explore the basics of nutrition therapy – Click Here
Food Allergies and Sensitivity – May 2021
Your Body’s Immune System – Apr 2020
Should I take Probiotics? – Nov 2020
Healthful Properties of Herbs and Spices – Feb 2015
For more information contact:
CCC Nursing Department
Ally Gottfried MFN, RD, LD | Phone: 541-673-2267
or Email: AGottfried@CCCRoseburg.org
Outreach Education | Patient Programming
Cancer Support Group
The Community Cancer Center cancer support groups are for anyone who is currently undergoing cancer treatments, is a cancer survivor, a co-survivor or for those who care for them.
Support groups provide a safe environment where members can freely express their thoughts and feelings without having to worry about upsetting a concerned family member or friend. Support group participants have an opportunity to vent about their fears, share their joy and hope or talk about their journey of treatment and healing.
Members have the option to attend up to four meetings each month. Although meetings have the same topic and learning component, each meeting is different based on the group dynamic. We encourage members to attend as many meetings as they are comfortable with.
For more information, registration, or questions about programs contact:
CCC Outreach Ed | Program Management
Angelia Freeman | Phone: 541-672-0072
or Email: AFreeman@CCCRoseburg.org
Tobacco Cessation Classes, Weekly Meetings & Youth Education
Do you want to quit smoking?
- DIMENSIONS: Tobacco Cessation Classes – The Community Cancer Center is now offering FREE smoking cessation classes. The DIMENSIONS: Tobacco Free Program is an evidence-based tobacco cessation program designed to teach participants the necessary information and skills to successfully quit tobacco use for life.Creating and maintaining physical health and wellness is a lifelong journey. The DIMENSIONS: Tobacco Free Program teaches information, skills, and strategies that can be used to build a healthy lifestyle and to stop tobacco use. This program is designed to assist individuals to envision and achieve their personal Tobacco Free goals. This innovative program provides training in effective community education as well as tobacco cessation services for individuals and groups. The DIMENSIONS: Tobacco Free Program is meant to complement other provider or peer services, such as the DIMENSIONS: Well Body Program for health related behaviors, which include nutrition, physical activity, sleep, and stress management. Our program is FREE and open to anyone ages 18 and over.
- Smoke-Free Pregnancy –The Smoke-Free Pregnancy Program is a series of classes designed to help women who are pregnant, or who plan to become pregnant, quit smoking cigarettes, e-cigarettes, and all other nicotine products. Participants meet once a week for 10 weeks and are provided with the tools to help them quit tobacco. Each session explores the top reasons to quit tobacco use, provides an improved understanding of the health risks of smoking, and designs a unique tobacco-free journey.
- INDEPTH – INDEPTH aims to address the problem around youth tobacco use—and focuses on all types of tobacco, including the growing issues around e-cigarettes. The INDEPTH program is an alternative to a suspension or citation program and can be offered as an option to youth who face suspension or consequences for violation of school tobacco or e-cigarette use, policies or community ordinances.
For more information, registration or questions about programs contact:
CCC Outreach Ed | Program Management
Angelia Freeman | Phone: 541-672-0072
or Email: AFreeman@CCCRoseburg.org
Additional Resources to Quit Smoking
- Become an EX – The EX Plan combines expertise from the Mayo Clinic with practical advice from ex-smokers. You won’t just quit smoking. You’ll “re-learn life without cigarettes.” It doesn’t matter if it’s your first try or your tenth, EX can help you quit and stay quit. Research shows that the more times people come to the EX site, the more likely they are to quit smoking.
- Freedom from Smoking Plus – Freedom from Smoking Plus has a great new look, updated content and activities and includes both online and phone support. The program also works well on smartphones and tablets so you can get help quitting smoking whenever, however and wherever works best for you.
- Guide to Quitting Smoking – This is an online guide from the American Cancer Society on quitting smoking or using smokeless tobacco. To have the best chance of quitting tobacco and staying quit, you need to know what you’re up against, what your options are and where to go for help. You’ll find this information here.
- Nicotine Anonymous – This is a 12-step fellowship of men and women helping each other live nicotine-free lives. Nicotine Anonymous welcomes all those seeking freedom from nicotine addiction, including those using cessation programs and nicotine withdrawal aids. The primary purpose of Nicotine Anonymous is to help all those who would like to cease using tobacco and nicotine products in any form. The Fellowship offers group support and recovery using the 12 Steps as adapted from Alcoholics Anonymous to achieve abstinence from nicotine.
- Oregon Tobacco Quit line – This is a free program offering tips, information, and one-on-one telephone counseling to anyone looking to quit tobacco use. You will also get assistance in determining if you are eligible for free nicotine gum or patches. Open seven days a week, 24 hours a day. Call 1-800-QUIT-NOW (1-800-784-8669).
- Quit for Life – We understand that quitting is about more than just not smoking. When you join our program, a Quit Coach® will help you become an expert in living without tobacco using “The 4 Essential Practices to Quit for Life,” principles based on 25 years of research and experience helping people quit tobacco.
- Smokefree.gov – On this site you’ll find support, tips, tools and expert advice to help you or someone you love quit smoking.
- Smokefree Teen – Want to quit but don’t know how? Get your daily dose of the support you crave. This site is designed and run by people at the National Cancer Institute to help teens take control of their health.
- SmokefreeVet – SmokefreeVET is a mobile text messaging service for military Veterans who receive their health care through VA. Visit Tricare to learn more about available tobacco cessation services.
Spiritual Care
At the Community Cancer Center, we offer spiritual care to comfort, console and provide emotional and spiritual support. Our Spiritual Care Volunteer offers pastoral counseling to patients, family, friends and staff.
The chaplain and pastoral care volunteers, together with our Community Cancer Center staff, offer comfort regardless of belief systems, traditions, ethnicity or values, and are respectful of cultural, religious or non-religious traditions. We can also assist you by contacting clergy of any faith tradition or a secular humanist consultant for those who are nonreligious.
For more information, registration or questions about programs contact:
CCC Outreach Ed | Program Management
Angelia Freeman | Phone: 541-672-0072
or Email: AFreeman@CCCRoseburg.org
Living Well Workshops
Living Well Program participants will learn the skills to become a positive self-manager by developing a proactive approach to their pain and working with their health care professionals. Adopting a positive management style, participants will live a healthier life. Sessions are progressive so participants will want to attend all sessions to gain the most benefit from the workshop.
Each Living Well workshop is six weeks in duration with participants meeting once per week for a two-and-a-half-hour session.
For more information, registration, or questions about programs contact:
CCC Outreach Ed | Program Management
Angelia Freeman | Phone: 541-672-0072
or Email: AFreeman@CCCRoseburg.org
Prevention
While genetics and other factors beyond your control can certainly play a role in being diagnosed with cancer, research shows that preventing all types of cancers starts with mastering a few key behaviors.
- Talk to your family to learn about family health history.
- Maintain a healthy weight by staying active and exercising regularly.
- Avoid smoking.
- Limit alcohol intake.
- Minimize red and processed meat intake, no more than 18oz a week and keep keep saturated fat intake less than 10% of your total fat consumption.
- Try and meet your daily recommended intake of all vitamins and minerals from your diet. Only take supplements to treat a deficiency or potential deficiency.
- Consume lean sources of protein.
- Eat more brightly colored vegetables and be sure to include green, leafy vegetables. We encourage consumption of a ‘Mediterranean Type Diet.’
- Maintain good mental health and seek treatment for stress-related issues or depression.
- Get control of high blood pressure or cholesterol.
- Avoid over-supplementation.
- Relax more and enjoy life.
- Early screening saves lives. Get regular screening for cancers such as breast and prostate as directed by your physician.
Learn more about breast cancer prevention and treatment.
Learn more about lung cancer prevention and treatment.
Learn more about prostate cancer prevention and treatment.
For a more detailed look at cancer prevention and risk factors we recommend visiting the American Institute for Cancer Research aicr.org