Figure 10: DETEC - Enroll Recipient online form

To access the DETEC – Enroll Recipient online form (Figure 10), a search must first be done for the recipient you are trying to enroll. For instructions on completing a search, see the DETEC – Search Recipient section . If a search does not find the recipient in the database, click the Add New Recipient link (Figure 9) to access the DETEC – Enroll Recipient online form.

Recipient Info

Note: An asterisk (*) means that the information is required.

Last Name: Enter last name of the recipient. If the recipient has only one name, enter name in the last name field and leave the first name blank.

First Name: Enter first name of the recipient.

Middle Initial: Enter middle initial of the recipient. If the recipient does not have middle initial, leave blank.

Date of Birth: Enter date of birth of the recipient in the space provided using the following format: MM/DD/YYYY.

Mother’s Maiden Name: Enter the recipient’s mother’s last name before marriage. This field allows a minimum of two and a maximum of 20 letters including hyphens.

Medical Record Number: Enter the record number your office assigns to the recipient.

Address: Enter residence address of the recipient. If homeless, enter the address where the recipient receives mail.

City: Enter name of the city in which the recipient lives or receives mail.

ZIP Code: Enter the ZIP code for the recipient’s residence or mailing address.

Phone Number: Enter the recipient’s telephone number, including area code. If the recipient has no telephone number, enter the telephone number of the recipient’s contact

Is the recipient Hispanic or Latino? Enter the recipient’s response to this question. This information is required. Please encourage applicants to provide race and ethnicity information.

• Even if the recipient responds “yes,” additional race information is desired.

Select all that apply to this recipient: Use the selection box to choose one or more race designation(s) that apply to the recipient. Selecting up to five race designations is allowed.

• If possible, avoid selecting “Unknown” for race. Complete race information is desired.

Asian – Select one: Use the drop-down box to select the sub-category of Asian if the recipient indicates that she is “Asian.”

Pacific Islander – Select one: Use the drop-down box to select the sub-category of Pacific Islander if the recipient indicates that she is “Pacific Islander.”

Certification Section

Meets CDP: EWC program age, income, and insurance criteria: Check this box if the recipient meets the program age, income, and insurance criteria.

• File the signed Recipient Eligibility form that validates that the recipient meets these criteria in the recipient’s medical record. This form is required to be completed and signed yearly and filed in recipient’s medical record.  

Signed CDP: EWC consent form: Check this box if the recipient has signed the program consent form. The recipient is required to sign this form yearly.

• File the signed consent and eligibility forms in the recipient’s medical record.

Breast and Cervical Cancer Treatment Program (BCCTP) Enrollment

BCCTP Enrollment Date: Enter the date that BCCTP enrollment was completed if a recipient is being enrolled into CDP: EWC only for referral to BCCTP. Enter the date using the following format: MM/DD/YYYY.  Please note: this action does not enroll a woman into BCCTP.  For those recipients who have been diagnosed with breast or cervical cancer or certain pre-cancerous conditions and are found to need treatment, please refer to the BCCTP area of the Medi-Cal website. For more information regarding the BCCTP, please call 1-800-824-0088 for a BCCTP Eligibility Specialist or visit the BCCTP website.

The purpose of this enrollment is to only refer the recipient to BCCTP for Breast Cancer treatment: Check the box if a recipient is being enrolled into CDP: EWC only for referral to BCCTP for breast cancer treatment. If this box is checked, the ability to add new breast screening cycles will be deactivated.

Breast Final Diagnosis Date: Enter the date of the diagnostic procedure leading to the final diagnosis using the following format: MM/DD/YYYY.

Breast Final Diagnosis: Select the final diagnosis from the drop-down list based on reports from diagnostic procedures.

The purpose for this enrollment is to only refer the recipient to BCCTP for Cervical Cancer treatment: Check this box if a recipient is being enrolled into CDP: EWC only for referral to BCCTP for cervical cancer treatment. If this box is checked, the ability to add new cervical screening cycles will be deactivated.

Cervical Final Diagnosis Date: Enter the date of diagnostic procedure leading to the final diagnosis using the following format MM/DD/YYYY.

Cervical Final Diagnosis: Select the final diagnosis from the drop-down list based on the reports from diagnostic procedures.

Save the data entered by clicking the Submit button at the bottom of the form.

If everything is complete, the DETEC – Enroll Recipient screen will become the DETEC – Recipient Information screen and a message will appear that you have successfully added this record. The Recipient ID and certification period will now appear at the top of the screen (Figure 11).

Figure 11: Successful enrollment of the DETEC – Recipient Information form.

Buttons allowing you to print the recipient information, and the recipient ID card are displayed at the bottom of the DETEC – Recipient Information form (Figure 12). Access to new Breast and Cervical Screening Cycle forms appears in the left column navigation bar (Figure 13).

To enroll another recipient, click the Return to Search button at the bottom of the screen or select Search/Add Recipient from the left column navigation bar.

Figure 12: Buttons at bottom of DETEC – Recipient Information form

Figure 13: DETEC left column navigation bar after completing enrollment.