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Every Woman Counts (EWC) Manuals, Forms and Worksheets

Every Woman Counts (EWC) Step-By-Step Provider User Guide

Consent to Participate in Program (Provider Use Only) Note:

The Consent to Participate in Program will be available in other languages at a later date.


Notice of Privacy Practices Form

The Notice of Privacy Practices can be downloaded from the Notice of Privacy Practices page of the DHCS website in English and the following languages:

  • Arabic
  • Chinese
  • Farsi
  • Hmong
  • Khmer
  • Korean
  • Russian
  • Spanish
  • Tagalog
  • Vietnamese
Recipient Eligibility Forms (Provider Use Only) Breast and Cervical Screening Cycle Data Worksheets & Instructions Covered Procedures
  • Breast Only Primary Care Provider Covered Procedures (DHCS 8471) (under revision)
  • Breast & Cervical Primary Care Provider Covered Procedures (DHCS 8472) (under revision)
  • Referral Provider Covered Procedures (DHCS 8473) (under revision)


Note:

If you cannot view the MS Word or PDF (Portable Document Format) documents correctly, please visit the Web Tool Box to link to a download site for the appropriate reader.