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Care For Yourself - Information for Health Care Providers

Before You Get Started...

Providers

Please review the Care for Yourself program guide first, to determine if the health care facility will be able to meet the program requirements.

If you have specific health care provider questions regarding the Care for Yourself program, please direct questions to 515-281-4909. Thank you for your partnership.

CFY - Breast and Cervical Cancer Program - Facility and Health Care Provider Application

Thank you for your interest to enroll as a Corporation/Lead Facility for the Care for Yourself - Breast and Cervical Cancer Program, please review the Health Care Facility and Health Care Provider Guide prior to completing the documents below.

The Breast and Cervical Cooperative Agreement is not effective until the document has been fully executed with signatures of both parties and received by the Corporation/Lead Facility. The fully executed agreement will be scanned and electronically sent back to the applicant.

To submit the required materials, please send them in an email to Gena.Hodges@idph.iowa.gov. The subject line should state “BCC Enrollment” and the Corporation/Lead Facility name. For further questions, please contact Gena Hodges at Gena.Hodges@idph.iowa.gov or 515-281-4909.

CFY- WISEWOMAN Program - Facility and Health Care Provider Application

Thank you for your interest to enroll as a Corporation/Lead Facility for the Care for Yourself - WISEWOMAN Program, please review the Health Care Facility and Health Care Provider Guide prior to completing the documents below. Approval to enroll in the WISEWOMAN Program is limited and pre-authorization to enroll as a Corporation/Lead Facility is required.

The WISEWOMAN Cooperative Agreement is not effective until the document has been fully executed with signatures of both parties and received by the Corporation/Lead Facility. The fully executed agreement will be scanned and electronically sent back to the applicant.

To submit the required materials, please send them in an email to Gena.Hodges@idph.iowa.gov. The subject line should state “WW Enrollment” and the Corporation/Lead Facility name. For further questions, please contact Gena Hodges at Gena.Hodges@idph.iowa.gov or 515-281-4909.

Change Form for Current Corportation/Lead Facility Enrollment Application

The Change Form for current Breast and Cervical Cancer and/or WISEWOMAN Facility and Health Care Provider Applications should only be completed when there are changes to the current application on file (i.e. facility name, address change, tax ID number, and/or health care provider update). The Corporation/Lead Facility Cooperative Agreement needs to be renewed every six years. To see if your Facility and Health Care Provider Application is up to date, please contact Gena Hodges at Gena.Hodges@idph.iowa.gov or 515-281-4909.