Get the free Breast Health Center Registration Form

This document serves as a registration form for patients visiting the Breast Health Center, collecting essential personal, insurance, and emergency contact information.

How to fill out breast health center registration

How to fill out Breast Health Center Registration Form

1. Obtain the Breast Health Center Registration Form from the relevant source, such as the clinic's website or front desk.
2. Read the instructions carefully to understand what information is required.
3. Start by entering your personal information, including your full name, date of birth, and contact information.
4. Provide your health history as requested, including any previous breast-related issues, surgeries, or treatments.
5. Fill out the insurance information section, providing details such as insurance provider, policy number, and group number if applicable.
6. Indicate your preferred appointment times and any specific concerns you want to address during your visit.
7. Review the completed form for accuracy and completeness.
8. Sign and date the form as required.

Who needs Breast Health Center Registration Form?

1. Individuals seeking breast health services, including screenings and consultations.
2. Patients requiring follow-up care after previous breast-related treatments.
3. Anyone looking for preventive care or educational resources about breast health.

People Also Ask about

What percentage of people get called back for a second mammogram?

Call the center or the hospital's main number. Ask to be transferred to the center or women's health center. Once you are transferred, ask who you should speak with about scheduling a free mammogram. If the receptionist doesn't know, ask to speak to a patient or nurse navigator.

How do you get a free mammogram?

Most private health plans available through the Affordable Care Act (ACA, also known as Obamacare) cover screening mammograms for women who are age 40 and older without cost-sharing. If you don't have insurance or don't have enough coverage, you may still be able to get a mammogram for free or at an affordable price.

Why would a mammogram not be covered by insurance?

Are mammograms covered by insurance? Screening mammograms used for preventive care are generally covered by insurance. (In fact, most preventive cancer screenings are.) But because a diagnostic mammogram is used to diagnose something, you may have to pay a copay or coinsurance, depending on your insurance plan.

Can you get a free mammogram in Pennsylvania?

We offer free cancer screening and diagnostic services to those who are 40 years and older, and uninsured or under-insured.

How much does a mammogram cost without insurance in PA?

Without insurance, the cost of a 2D screening mammogram can range from less than $200 to more than $300. More advanced scans typically cost more. With insurance, your out-of-pocket expenses can vary based on your health plan, the type of imaging you need, and where the procedure is performed.

Do I need a prescription for a mammogram in PA?

Yes. Diagnostic mammography, ultrasound, and MRI require a prescription from your health care provider.

How do I make an appointment for a exam?

MyLVHN app users should select the Appointments icon and then press Schedule an Appointment. Don't have an account? Opens in new tab Sign up for MyLVHN. For assistance scheduling your test, call 888-402-LVHN (5846).

For pdfFiller’s FAQs

What is Breast Health Center Registration Form?

The Breast Health Center Registration Form is a document used by healthcare facilities to officially register as a breast health center, detailing their services and capabilities in breast health care.

Who is required to file Breast Health Center Registration Form?

Healthcare providers and facilities that offer breast health services, including diagnostic imaging, treatment, and education related to breast health, are required to file the Breast Health Center Registration Form.

How to fill out Breast Health Center Registration Form?

To fill out the Breast Health Center Registration Form, providers must gather relevant information about their facility, including service offerings, staff qualifications, equipment used, and compliance with regulations, and enter this information in the designated sections of the form.

What is the purpose of Breast Health Center Registration Form?

The purpose of the Breast Health Center Registration Form is to ensure that breast health centers meet established standards and requirements, enhance the quality of care provided, and facilitate monitoring and regulation of breast health services.

What information must be reported on Breast Health Center Registration Form?

The Breast Health Center Registration Form must report information such as the facility name and address, types of services offered, qualifications of healthcare providers, equipment available, and any accreditation or certification obtained.