Medium
Medium
Women's Way Forms
- Authorization for Disclosure of PHI
- Authorization for Disclosure of PHI - Spanish-English
- Demographic Form
- Demographic Form - Spanish
- Intake and Visit Form
- Breast Diagnostic Form
- Cervical Diagnostic Form
- Women's Way Referral Form
- Process to Complete Secure Mail Transmittal
- BCBS Secure Transmittal Form
- Other Organizations Secure Mail Form
- Informed Refusal Form
- NDQuits Fax Referral Form
Medicaid Forms
Medium
Women's Way Policies and Practices
- Breast Cancer Screening Policy
- Cervical Cancer Screening Policy
- Enrollment Policy for Clients Outside LCU
- LCU Process for Reviewing Paid Claims
- Backdating Enrollments or Re-enrollments
- Adherence for Completed Screens/Follow-up
- Informed Refusal Policy
- Community Clinical Linkages, Encounters & Outreach
- Utilization of Women's Way Logo