Hepatocellular Carcinoma Surveillance/Recall Note

Patient: [name, MRN, DOB]

Date/Time: [date and time of note]

Author/Role: [name, credentials/role]

Encounter Type: [Surveillance results review / Surveillance planning / Recall after abnormal test]

Liver Disease Context: [etiology, cirrhosis status, transplant listing status if relevant]

Surveillance Eligibility

• Indication: [reason patient qualifies for HCC surveillance]
• Treatment candidacy: [candidate for HCC-directed therapy or transplant / not a candidate — rationale if not candidate]
• Enrollment status: [active / paused / discontinued] — [date] (If paused or discontinued, include reason.)

Action Needed: [clarification of treatment candidacy required before ordering further surveillance] (Only include if candidacy is uncertain.)

Surveillance Status

• Current status: [on schedule / due now / overdue / in recall / in diagnostic evaluation]
• Last surveillance test: [date] — [modality] — [facility]
• Ultrasound visualization score: [A / B / C / not reported] (Only include if ultrasound was used. State "not reported" explicitly if absent; flag as data quality item if it affects modality choice.)
• Result classification: [negative / subthreshold <10mm / positive ≥10mm or other positive feature / non-diagnostic]
• AFP: [value, units, date] — [normal / elevated / rising] (If rising, document definition applied and source dates. Do not infer trend without documented data.)
• Recall tier: [routine q6mo / short-interval 3–6mo / diagnostic CT-MRI now / AFP-triggered workup]
• Next planned test: [modality] — [due date]
• Lesion tracking: [number of lesions, size category] (Only include if lesions present. For multiple lesions requiring longitudinal tracking, reference lesion registry location.)

Assessment & Plan

• Recall decision: [tier] — [rationale based on surveillance result and/or AFP trend]
• Test ordered: [modality, contrast type if relevant] — [order/authorization status] — [target completion date]
• Subcentimeter lesion plan: [short-interval timeframe and criteria for return to routine surveillance] (Only include if applicable.)
• Positive surveillance plan: [diagnostic multiphasic CT or MRI] — [target completion window] (Only include if ≥10mm or other positive features.)
• AFP-triggered recall: [threshold/trend definition applied] — [imaging plan] (Only include if applicable.)
• Diagnostic imaging results: [benign / indeterminate / probable–definite HCC] — [next pathway: return to surveillance / repeat imaging interval / tumor board or hepatobiliary surgery referral] (Only include if diagnostic imaging completed. State explicitly if patient has transitioned from surveillance to confirmed HCC pathway.)
• Barriers/Pending: [scheduling status, insurance issues, patient contact issues, other logistics] (Omit if none.)

Communication & Follow-Up

• Communication: [content communicated] — [recipient: patient / caregiver / referring clinician] — [method] — [date] — [response: understanding / agreement / refusal] (Document refusal explicitly with details.)
• Responsibility assignment: [person responsible for confirming test completion and reviewing results] — [target follow-up date]
• Contact attempts: [attempt count, dates, methods] — [next contact plan] (Only include if patient unreachable.)

(Omit fields or sections that are not applicable. Do not infer visualization scores or AFP trends; document only what is explicitly available.)