For health care providers: BCCHP manual and forms

NOTE:  Forms are for the use of BCCHP-contracted clinics ONLY. If your clinic or provider is not currently contracted for BCCHP services have the clinic manager call 206-263-8205 to set up the contracting process.

	BCCHP background
	BCCHP Contractor's Procedure Manual
	Algorithms
	Cancer treatment and case management forms
	Colon health forms
	Consent forms
	Diagnostic and reimbursement forms
	Enrollment forms
	Exam and reimbursement form (PDF)
	Fee schedules

• English
• Chinese
• Khmer (Cambodian)
• Korean
• Russian
• Spanish
• Vietnamese

If you're a healthcare provider and you'd like a copy of the Breast, Cervical & Colon Health Program (BCCHP) Contractor Procedure Manual, please contact Heather Fluegel at Heather.Fluegel@kingcounty.gov

• BCCHP Contractor's Procedure Manual (PDF)

• BCCHP Breast Care Algorithm
  • Breast Care Algorithm Key
  • Breast Care Algorithm Notes
    
    
• BCCHP Cervical Care Algorithm
  • Cervical Care Algorithm Key
  • Cervical Care Algorithm Notes
    
    
• Colon Health Screening Algorithm
  
  
• Colon Health Program Clinical Screening Guide for CRC
  
  
• Colorectal Cancer Screening Algorithm for Adults Aged 50 Years and Older
  
  
• Clinical Coordination - Breast Health Services – BCCHP

• Breast and cervical cancer tracking form
• Case Management - Client Comprehensive Needs Assessment
• Citizenship Documentation and Identity Declaration
• Estate Recovery fact sheet (Washington State DSHS)
  
  
• Release and consent for cancer treatment:
  • English
  • Chinese
  • Khmer (Cambodian)
  • Korean
  • Russian
  • Spanish
  • Tagalog

• Colon history/exam screening form
• Colon diagnostic and reimbursement form

• Consent for release of information, Health Screening Program of Washington (HSP):
  • English
  • Chinese
  • Khmer (Cambodian)
  • Korean
  • Russian
  • Spanish
  • Tagalog
  • Vietnamese

• Breast evaluation reporting and reimbursement form
• Breast diagnostic and reimbursement form
• Cervical diagnostic and reimbursement form

• Health screening program enrollment form:
  • English
  • Chinese
  • Khmer (Cambodian)
  • Korean
  • Russian
  • Spanish
  • Tagalog
  • Vietnamese
    
    
• Health screening program enrollment form (male colon screening only)

• Colon Health Program Fee Schedule
• Health Screening Program of Washington Fee Schedule