Background: This retrospective study harnessed an institutional cancer registry to construct a childhood cancer survivorship cohort, integrate electronic health record (EHR) and geospatial data to risk stratify patients for serious adverse health outcomes, analyze follow-up care patterns, and determine factors associated with suboptimal follow-up care. Procedure: The survivorship cohort included patients ≤18 years of age with a diagnosis of a malignancy reported to the institutional cancer registry between January 1, 1994 and November 30, 2012. ICD-O-3 coding and treatment exposures facilitated risk stratification of survivors. All follow-up visits were extracted from the EHR through linkage to the cancer registry based on medical record number (MRN). Results: Eight-hundred-and-sixty-five survivors were included in the final analytic cohort, of whom 191, 496, and 158 were considered low, intermediate, and high risk survivors, respectively. Two-hundred-and-eight-two survivors (32.6%) were not seen in any oncology-related subspecialty clinic at Duke five to seven years after initial diagnosis. Factors associated with a clinic visit included younger age (p=0.008), acute lymphoblastic leukemia (ALL) as the primary diagnosis (p<0.001), race/ethnicity (p=0.010), risk strata (p=0.001), distance to treatment center (p<0.0001), and lower ADI (p=0.011). Multivariable logistic modeling with adjustment for diagnosis of ALL, gender, age at diagnosis, and race/ethnicity attenuated the association between follow-up care and risk strata (p=0.17) Conclusions: Nearly a third of survivors received suboptimal follow-up care. This study provides a reproducible model to integrate cancer registry and EHR data to construct risk-stratified survivorship cohorts to assess follow-up care.