APFF Cancer Registry Form
Thank you for your time and effort. Please enter information as accurately as possible.
Name of firefighter (optional, but helpful to avoid duplication) and name of respondent (if someone other than the firefighter)
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Date of birth
Department and hire date
Total years of service
Date of diagnosis and separation of employment
Type of cancer and brief narrative of the outcome
Other risk factors and relevant medical history
Additional career/volunteer departments and years of service. Concurrent or prior.
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