Breast and Cervical Health Program manual and forms

	Breast, Cervical & Colon Health Program brochure
	Washington Breast and Cervical Health Program (WBCHP) background
	Breast, Cervical & Colon Health Program - Contractor's Procedure Manual
	Algorithms

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. Cancer treatment and case management forms Consent forms Enrollment forms Exam and reimbursement forms Fee schedules

English Chinese Khmer (Cambodian) Korean Russian Spanish Tagalog Vietnamese

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

• Complete manual with all chapters (561 Kb)
  
  
• Manual separated by chapter:
  • Chapter 1: Introduction
  • Chapter 2: Program Eligibility
  • Chapter 3: WBCHP Breast Care Algorithm
  • Chapter 4: Clinical Responsibilities and Follow-up
  • Chapter 5: Mobile Health Screenings
  • Chapter 6: Outreach / Public Education
  • Chapter 7: Billing Procedures and Payment

• WBCHP Breast Care Algorithm
  • Breast Care Algorithm Key
  • Breast Care Algorithm Notes
    
    
• WBCHP Cervical Care Algorithm
  • Cervical Care Algorithm Key
  • Cervical Care Algorithm Notes
    
    
• Colorectal Cancer Screening Algorithm for Adults Aged 50 Years and Older

• 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

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

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

• Exam and reimbursement form
  
  
• Exam and reimbursement form (male colon screening only)

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