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Breast & Cervical Cancer Control Navigation Program Local Coordinating Agency #15 BC3NP REFERRAL & AUTHORIZATION FORM Enrolled CLIENT NAME: ___ DATE OF BIRTH: ___ Enrollment/Screening SITE: ___ Enrollment

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Breast cancer nowform research is a research form specifically focused on gathering information related to breast cancer for research purposes.

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Medical professionals, researchers, and organizations conducting studies on breast cancer are required to file breast cancer nowform research.

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Information such as study design, participant demographics, data collection methods, results, and conclusions must be reported on breast cancer nowform research.

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