Get Screening Form Mammogram/pap Test Screening Results ... - Michigancancer
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How to use or fill out the SCREENING FORM Mammogram/Pap Test Screening Results online
Completing the SCREENING FORM for Mammogram and Pap Test Screening Results is an essential step in ensuring proper monitoring and care. This guide will provide you with clear, step-by-step instructions to help you fill out the form accurately and efficiently, ensuring that you receive the necessary follow-up care.
Follow the steps to fill out the screening form successfully.
- Press the ‘Get Form’ button to access the screening form and open it for editing.
- Begin by entering the enrollment site name in the designated space.
- Note the date you enrolled into the program by filling in the appropriate fields with the day, month, and year.
- Fill in your last name, first name, and birth date to identify yourself clearly.
- Indicate your age in the provided field.
- Circle the relevant answer for whether your mammogram, ultrasound, or pap test result(s) were obtained from a non-BCCCP provider.
- Confirm whether you have a copy of the test results by circling ‘Yes’ or ‘No.’
- For the mammogram section, indicate if it was a screening or diagnostic and provide the referral date to BCCCP.
- Input the date of the ultrasound (if applicable) and the facility where it was performed.
- Provide results for the mammogram and follow-up if any were taken, including the date performed and the facility name.
- Fill in the results for the ultrasound per the provided options and indicate the side (right/left) as necessary.
- Select the appropriate results from the ACR ratings provided for both mammogram and ultrasound.
- Document any additional work-ups that may be required and specify details in the given area.
- In the follow-up procedures section, list any scheduled or obtained follow-ups, including dates.
- For the pap test section, indicate the type (conventional or liquid-based), and fill in the date and facility.
- Mark the adequacy of the pap test as satisfactory or unsatisfactory and fill out any necessary follow-up procedures.
- Ensure all information is accurate, then save changes, and choose to download, print, or share the form as needed.
Complete your screening form online today to take a proactive step in managing your health.
Yes, you generally need a prescription or referral from your healthcare provider for a screening mammogram. This ensures that your provider assesses your health history and risk factors appropriately. If you are unsure about the process, contacting your provider for guidance is advisable. The SCREENING FORM Mammogram/Pap Test Screening Results ... - Michigancancer can help clarify what you need for your screening.