Get the free Oregon Breast and Cervical Cancer Program Enrollment Form - public health oregon
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This form is used for enrolling patients in the Oregon Breast and Cervical Cancer Program (BCCP) and the WISEWOMAN Program, capturing personal, eligibility, and demographic information necessary for
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How to fill out Oregon Breast and Cervical Cancer Program Enrollment Form
01
Obtain the Oregon Breast and Cervical Cancer Program Enrollment Form from the official website or a local health department.
02
Fill in your personal information at the top of the form, including your name, address, date of birth, and contact information.
03
Provide details on your insurance status and any prior cancer screenings or diagnoses.
04
Complete the section regarding your income and household size to determine eligibility.
05
Sign and date the form to certify that the information provided is accurate.
06
Submit the completed form to your local health department or designated program office for processing.
Who needs Oregon Breast and Cervical Cancer Program Enrollment Form?
01
Women aged 40 and older who need breast cancer screening and diagnosis.
02
Women aged 21 and older who need cervical cancer screening and diagnosis.
03
Individuals who are uninsured or underinsured and meet income eligibility criteria.
04
Those seeking assistance with accessing medical care for breast or cervical cancer.
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People Also Ask about
What is the and cervical cancer program in Oregon?
The and Cervical Cancer Treatment Program (BCCTP) is a Medicaid program that gives access to the Oregon Health Plan (OHP) to uninsured or underinsured individuals in need of or cervical cancer treatment.
What are cancer patients entitled to?
United Cancer Foundation's Individual Grant Program supports people who are receiving treatment for cancer or who have been in remission for three years or less by covering expenses such as medical procedures, prescription medicines, COBRA insurance coverage, housing expenses, utilities, transportation
Do cancer patients automatically qualify for Medicaid?
2:09 2:56 And programs are available. To learn more check out these links which you can click in theMoreAnd programs are available. To learn more check out these links which you can click in the description. Below.
How to apply for BCCTP?
Apply at your County Social Services Office If your doctor told you that you have a and/or cervical cancer diagnosis, tell one of the county workers so that they can send your information to BCCTP. A BCCTP Eligibility Specialist will reach out to you directly to start an application.
Who is eligible for the Bcctp program?
You may be eligible for the BCCTP program if you: Live in California. A doctor told you that you have and/or cervical cancer and need treatment. Your monthly paycheck (gross income) is less than $2,510 before taxes are taken out for a household size of one (1) person.
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What is Oregon Breast and Cervical Cancer Program Enrollment Form?
The Oregon Breast and Cervical Cancer Program Enrollment Form is a document used to enroll eligible individuals in a program that provides breast and cervical cancer screening and diagnostic services.
Who is required to file Oregon Breast and Cervical Cancer Program Enrollment Form?
Individuals who are seeking access to breast and cervical cancer screening and diagnostic services under the Oregon Breast and Cervical Cancer Program are required to file this enrollment form.
How to fill out Oregon Breast and Cervical Cancer Program Enrollment Form?
To fill out the form, individuals should provide their personal information, including name, address, and contact details, and complete the required sections regarding income, insurance status, and demographic information as instructed on the form.
What is the purpose of Oregon Breast and Cervical Cancer Program Enrollment Form?
The purpose of the form is to collect necessary information to determine eligibility for cancer screening services, ensuring that individuals receive appropriate cancer detection and prevention resources.
What information must be reported on Oregon Breast and Cervical Cancer Program Enrollment Form?
The information that must be reported includes personal identification details, income level, insurance status, demographic information, and any prior history of breast or cervical cancer screenings.
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