Every Woman Counts (EWC) Manuals, Forms and Worksheets

Manuals

• Every Woman Counts Provider Manual (ev woman)
• Step-By-Step Provider User Guide

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 Application (Provider Use Only)

• Recipient Application (DHCS 8699, English)
• Recipient Application (DHCS 8699, Spanish)
• Recipient Application (DHCS 8699, Chinese)
• Recipient Application (DHCS 8699, Vietnamese)

Provider Data Request Form

• Breast Cancer (BCA) Screening Cycle Worksheet (EWC DETEC)
• Cervical Cancer (CCA) Screening Cycle Worksheet (EWC DETEC)
• Enrollment and Recipient Cycles Data Request Form (DHCS 8646, fillable PDF version)

Covered Procedures

• Breast Only Primary Care Provider Covered Procedures (DHCS 8471)
• Breast and Cervical Primary Care Provider Covered Procedures (DHCS 8472)
• Referral Provider Covered Procedures (DHCS 8473)

More information can be found at the DHCS EWC webpage.