Medium
Medium
Women's Way Forms
- Authorization for Disclosure of PHI
- Authorization for Disclosure of PHI - Spanish
- 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
- Medicaid-Women's Way Application
- Estate Recovery
- Verification of Diagnosis
- Completion of Treatment Form
- ND Medicaid BCCEDP Checklist for LCUs
- ND Medicaid BCCEDP Fact Sheet for Women's Way Clients
- Options For WW Clients Who Need Treatment
- Process to Complete Authorization to Disclose Information for ND DHS
- Authorization to Disclose Information for ND DHS
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
- Standards for Women's Way Logo