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Program Manual
Breast and Cervical Cancer Control Program
NC BCCCP Manual, Edition 16, June 2021
000 - Memo
001 - ProgramManual Cover
002 - Table of Contents
100 - BCCCP Overview Divider
101 - BCCCP Overview Handout
102 - Sample BCCCP AA
103 Sample SoW
104 - BCCCP Screening and Follow-Up Protocol - Updated 6/22
105 - Navigator Responsibilities - Updated 6/22
106 - NC BCCCP ACA - Updated 6/22
107 - NC BCCCP Cervical Screening Policy
108 - NC BCCCP Colorectal Cancer Screening Policy - Updated 6/22
109 - NC BCCCP Diagnostic Cap Policy - Updated 6/22
110 - BCCCP Family Planning
111 - Patient Navigation Policy
112 - NC BCCCP Risk Assessment Policy - Updated 6/22
200 - Eligibility Divider
201 – Federal Poverty Guidelines – Updated 01/23
202 – Sliding Fee Schedule – Updated 01/23
203 - BCCCP Eligibility FAQ – Updated 11/22
204 - Breast Eligibility Flow Chart – Updated 11/22
205 - Cervical Eligibility Flow Chart – Updated 11/22
300 - Budget Divider
301 - Placeholder for Budget PowerPoint or Enduring Materials Links
302 - BCCCP Fee Schedule
–
Updated 01/22
302A - WW Fee Schedule
–
Updated 01/22
303 - LHD Monthly Expenditure Report
304 - Placeholder for Contract Expenditure Report Instructions
305 - Placeholder for Contract Expenditure Report Template
306 - Placeholder for FY 21-22 CER Tracking Log
307 - Agency Action Plan Fillable
400 - Patient Navigation Divider
401 - Patient Navigation Kit August 2021
402A – Page 1 – PN Needs Assessment and Care Plan
402A – Page 2 – Screening/PN Only Tracking Tool/Data Reporting Form Instruction Sheet
402A – Page 3 – PN Data Reporting Form
402B - Patient Navigation Kit Appendix NC Cancer Survivorship Resource Toolkit Cover
402C - Patient Navigation Kit Appendix NC Cancer Survivorship Checklist in treament
402D - Patient Navigation Kit Appendix NC Cancer Survivorship Checklist finished treament
402E - Patient Navigation Kit Appendix My Unexpected Journey Journal
500 - Quality Assurance Divider
501 - Monitoring Process
502 - NCBCCCP Provider Performance Monitoring and Evaluation
503 - Pre Assessment Survey
504 - Triennial Program Review
505 - BCCCP-Clinical-Record-Review
506 - Corrective Action Plan Template
507 - Most Common Reasons for CAPs
508 - QI Recommendations Template
600 - Data Entry Divider
601 - Data Entry PowerPoint Handouts
602 - Data Training Mapping Guide
603 - BCCCP Codes for the Comment Field
604 - BCCCP Error Messages
605 - BCCCP Timeliness and Adequacy of follow up Algorithms
606 - Provider Codes
700 - Recruitment & Marketing Divider
701 - Recruitment Presentation Handout
702 - Recruitment Reporting Form
703 - NC BCCCP Services Brochure
704-NC BCCCP Do You Need Breast Cancer Screening – English – Updated 01/22
705 NC BCCCP Do You Need Breast Cancer Screening – Spanish – New 01/22
706 – NC BCCCP Do You Need Cervical Cancer Screening – English – Updated 01/22
707 – NC BCCCP Do You Need Cervical Cancer Screening – Spanish – New 01/22
708 – Materials Order Form
800 - Professional Development Divider
801 - Professional Education Websites
900 - BCCM Divider
901 - BCCM Presentation Handout
902 - BCCM Flyer Rev. 8/21
903 - Additional BCCM Info
904 - DMA-5087 Checklist
905 - DHB-5087-SP
906 - DHB-5079
907 - DHB-5079-SP
908 - DMA-5081
909 - DHB-5081-ia-SP
910 - DMA-5081R-ia
911 - DMA-5081-R-SP
912 - Non BCCCP Funding Sources
913 - NCONA 2021 Resource Guide
914 Komen Treatment Assistance Flyer - English
915 Komen Treatment Assistance Flyer - Spanish
916 Komen Breast Cancer Helpline - English
917 Komen Breast Cancer Helpline - Spanish
1000 - Forms Divider
1001 - Staff Change Notification Form 2021-09-02
1002 - BCCCP Consent English
1003 - BCCCP Consent Spanish
1004 - BCCCP H&P Form
1005 - Physician Letter re Covered Services
1006 - BCCCP Breast Screening Data Form
1007 - BCCCP Cervical Data Forms
1008 - Patient Navigation Only Data Collection Form
1009 QuitlineNC Fax Referral Form English
1010 QuitlineNC Fax Referral Form Spanish
1011 Declination Form English
1012 Declination Form Spanish
1100 - Comprehensive Cancer Control Program Divider
1101 - NC Comp Cancer Presentation Handout
1102 - NC Comp Cancer Overview.pdf
1103 - Breast Cancer Fact Sheet 2021 NC CCCP
1104 - Cervical Cancer Fact Sheet 2021 NC CCCP
1105 ExpandYourHorizons Partner Guide NC CCCP
1106 – NC CCCP Resource Toolkit Order Form
1200 - NC WISEWOMAN Program Divider
1201 – NC WISEWOMAN Program Summary - Updated 1/5/2023
1202 - NC WISEWOMAN Postcard
1300 - Cancer Branch Staff Divider
02/09/2023
1301 - Nurse Consultant Map
01/04/2023
1302 - CB Staff Roster
02/09/2023
