Get the free Breast Cancer Screening - New York State Department of Health
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BREAST SCREENING
INTAKE FORMTodays Date: ___/___/___SECTION A: PERSONAL INFORMATION (PLEASE FILL IN ALL SPACES TO QUALIFY FOR PROGRAM)
Name:___Date of Birth: ___/___/___Home Address (Street, City,
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How to fill out breast cancer screening
How to fill out breast cancer screening
01
Schedule a mammogram appointment with your healthcare provider or a imaging center.
02
Prepare for the mammogram by not wearing deodorant, lotion, or perfume on your breasts or underarms.
03
During the mammogram, stand in front of the machine and your breast will be placed on a flat plate.
04
The technician will then lower a second plate to compress your breast for a few seconds to get the X-ray image.
05
After the procedure, wait for the results from your healthcare provider.
06
Follow up with any additional tests or treatments if necessary.
Who needs breast cancer screening?
01
Women who are 40 years old and older should get breast cancer screening regularly.
02
Women with a family history of breast cancer or other risk factors may need to start screening at a younger age.
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What is breast cancer screening?
Breast cancer screening is a method of detecting breast cancer at an early stage through various tests such as mammograms, clinical breast exams, and self-exams.
Who is required to file breast cancer screening?
Women above a certain age or with a family history of breast cancer are generally required to undergo breast cancer screening.
How to fill out breast cancer screening?
Breast cancer screening can be filled out by scheduling an appointment with a healthcare provider for a mammogram or conducting regular self-exams and clinical breast exams.
What is the purpose of breast cancer screening?
The purpose of breast cancer screening is to detect breast cancer early when it is more easily treatable and to reduce the risk of mortality.
What information must be reported on breast cancer screening?
Information such as personal and family medical history, previous breast cancer screenings, and any symptoms or changes in the breast must be reported on breast cancer screening forms.
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