Care for Yourself Coordinator Tools

Program Guidelines

CFY Policy Manual - Updated version coming soon!
CFY 2022 Income Guidelines Updated March 2022
HIPAA Letter - Attorney General

Program Resources

Electronic CFY Program Materials Order Form
CFY Service Area Map - May 2022
County Numbers
FY 22 Program Directory - April 2022
FY 22 Calendar of Events
Patient Navigation Frequently Asked Questions
BCCT Presumptive CFY Coordinator Directory

Program Forms

BCC (Limited) Consent Form - March 2022
BCC (Limited) Spanish Consent Form - March 2022
BCC Patient Navigation Only Consent Form - March 2022
BCC Patient Navigation Only Spanish Consent Form - March 2022
Verbal Consent Form - March 2022
Annual Enrollment - March 2022
Fillable Annual Enrollment - March 2022
Spanish Annual Enrollment - March 2022
Screening Form - March 2022
Patient Navigation Form - March 2022
Breast Diagnostic - March 2022
Cervical Diagnostic - March 2022
WW Case Management/Plan of Care - Fillable Form
Inactive-Reactive Form for BCC/WW - Updated September 2016

Clinical Services Information

For a current listing of enrolled health care facilites please contact Gena Hodges at gena.hodges@idph.iowa.gov or 515-314-8318

Electronic Billing Guidance - Updated September 2017

University of Iowa Database Resources

Refusal of Care Follow-Up Form - BCC Services

If you need access to the "Refusal of Care - Follow-Up Form" for breast and cervical cancer screening services, please contact Jolene Carver. Jolene can be reached at jolene.carver@idph.iowa.gov or 515-242-6200. Please review page 20 of the Care for Yourself Policy Manual for guidance on how to complete the refusal of care form.

Educational Materials

Educational materials are now available at the Iowa Department of Public Health. Please allow one week for mailing of materials.