Form preview

Get the free Every Woman Counts Program – Primary Care Provider Enrollment Agreement

Get Form
This document outlines the enrollment agreement for Primary Care Providers participating in the Every Woman Counts Program, detailing provider eligibility, application submission, compliance requirements, billing practices, and support for case management services for breast and cervical cancer screening.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign every woman counts program

Edit
Edit your every woman counts program form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your every woman counts program form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit every woman counts program online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use the services of a skilled PDF editor, follow these steps below:
1
Sign into your account. In case you're new, it's time to start your free trial.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit every woman counts program. Rearrange and rotate pages, insert new and alter existing texts, add new objects, and take advantage of other helpful tools. Click Done to apply changes and return to your Dashboard. Go to the Documents tab to access merging, splitting, locking, or unlocking functions.
4
Save your file. Select it from your records list. Then, click the right toolbar and select one of the various exporting options: save in numerous formats, download as PDF, email, or cloud.
pdfFiller makes dealing with documents a breeze. Create an account to find out!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out every woman counts program

Illustration

How to fill out every woman counts program

01
Visit the Every Woman Counts program website.
02
Check your eligibility for the program based on your age and income.
03
Complete the application form provided on the website.
04
Submit any required documentation, including proof of income and identification.
05
Wait for confirmation of your application status via email or postal mail.
06
If approved, schedule your screening appointments as directed.
07
Attend your scheduled appointments and receive your screenings.

Who needs every woman counts program?

01
Women who are uninsured or underinsured.
02
Women ages 40 and older who need breast cancer screening.
03
Women 21 and older who need cervical cancer screening.
04
Low-income women who may not have access to regular healthcare services.
05
Women who have a family history of breast or cervical cancer.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.4
Satisfied
28 Votes

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

When you're ready to share your every woman counts program, you can swiftly email it to others and receive the eSigned document back. You may send your PDF through email, fax, text message, or USPS mail, or you can notarize it online. All of this may be done without ever leaving your account.
The editing procedure is simple with pdfFiller. Open your every woman counts program in the editor. You may also add photos, draw arrows and lines, insert sticky notes and text boxes, and more.
On Android, use the pdfFiller mobile app to finish your every woman counts program. Adding, editing, deleting text, signing, annotating, and more are all available with the app. All you need is a smartphone and internet.
Every Woman Counts (EWC) is a program that provides free or low-cost breast and cervical cancer screening and diagnostic services to eligible women in the United States.
Organizations and healthcare providers that participate in the Every Woman Counts program are required to file necessary documentation to maintain their participation and funding.
To fill out the Every Woman Counts program application or forms, individuals or organizations should follow the specific guidelines provided by the program, typically involving personal or organizational information and documentation of eligibility.
The purpose of the Every Woman Counts program is to reduce deaths from breast and cervical cancer by promoting early detection and providing access to timely screening and follow-up services.
Participants must report demographic information, screening results, follow-up actions taken, and participation rates to ensure compliance and effective program evaluation.
Fill out your every woman counts program online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.