The LCSR database is a repository for all lung cancer screenings regardless of payer and patient eligibility, so you should add a patient’s exam data regardless of whether it is for a ‘self-pay’ patient, private insurance, Medicaid, etc.

A new exam should be created for either a baseline or annual screening. If a patient is receiving a screening exam for the first time, submit the exam as a baseline screening, otherwise, if the patient is returning for a second or subsequent screening, submit the exam as an annual screening in your response to Section A question 6A10. Indication For Exam.

Any additional interim visits such as imaging, biopsy, or surgery occurring within 12 months of a screening should not be submitted as a new exam. Rather, the interim visit data should be added to the most recent screening exam record on the Exam form, in Section B as a ‘follow up’ record. See Manual Entry: Section B ‘Follow-up Within 1 Year’ for details on creating a follow-up record for an exam.

Register a new exam by clicking Register New Exam in the LCSR Data Collection 

menu and complete the form as follows; refer to the LCSR Data Dictionary for more detailed information on each data element.

Note: The form cannot be submitted until all fields marked with an asterisk are filled.


Field Name


Facility Number

This field is filled in automatically, as determined by the user’s profile

Registry Exam Number

This field is filled in automatically.

Patient Information

If this is an exam for a Returning Patient you can Search for LCSR Patients to retrieve the patient’s information from LCSR.

Otherwise, enter data to create a new patient record by completing the fields below.

*Patient SSN

Patient Social Security Number must be in the format NNN-NN-NNNN, where N is a digit; all 9 digits are required.

*Medicare Beneficiary ID

The Medicare Beneficiary ID, also known as the Medicare Health Insurance Claim Number, is required for Medicare reimbursement. Enter this field without any special characters. For example, if a beneficiary ID is 123-34-5678A, enter it as 123345678A.

Other Identification

If neither the Patient SSN nor Medicare Beneficiary ID is provided, then the Other Identification field must be filled in. It must be a code that uniquely identifies the patient within your practice, such as a medical record number.

Last Name

First Name

First and last names must be 2 to 45 characters. At least one character must be from the characters “A-Z”, “a-z”, or “ ‘ “ (apostrophe). Additional characters may include “ - “ (hyphen), provided the hyphen is not in the first or last position. First Name may also be an initial followed by a period.

Middle Name

Middle Name is optional and must start with a letter. The remaining characters can be letters or the characters “ ‘ “ (apostrophe), “ – “ (hyphen), or “ . “ (period).

*Date of Birth

Date of Birth must be at least three weeks prior to the current date.

*Patient Sex 

Select the patient’s gender.


Select the patient’s race(s), as identified by the patient. More than one race may be selected.

Patient Ethnicity (Hispanic Origin)

Select whether the patient is of Hispanic origin, as identified by the patient.

Health Insurance

Select all forms of health insurance that apply.

Date of Death:

In the event the patient has died, enter the patient’s date of death in mm/dd/yyyy format. Enter the cause and how the cause was determined, if available.

*Examination Date

Enter the date the exam was completed in mm/dd/yyyy format. The date cannot be later than the current date.

*Name of person who completed this paper form

Enter the name of the person who collected the data for this exam. If this name has not been previously entered in an exam record, select Add New and enter the person's first and last name. In the future, the name will appear in the drop-down list for this field. If the name has been previously entered, click the arrow and select it from the drop-down list.

Note: Please populate this field even if paper forms were not used. It can contain the name of the person completing the on-line data submission.

To delete a name from the list, select it and then click the Delete Person button.

LCSR Exam Form - Person Who Completed Paper Form

Name of person submitting form

Submission Date

These fields are filled in automatically.

Once you have entered all Patient Information, proceed to Section A ‘General Information’ to enter exam data.

Alternatively you can click the Save button to save your progress and complete the form later.

Previous: LCSR Data Submission OverviewNext: Section A 'General