1. Provider’s Guide to Accessing Women’s Health Care

2. What is your patient’s concern? Needs a pap smear or evaluation/treatment for an abnormal pap smear. Needs a pap smear or evaluation/treatment for an abnormal pap smear. Needs contraception or STI testing, treatment or vaccines Needs contraception or STI testing, treatment or vaccines Having abnormal uterine bleeding Having pelvic pain Needs a screening mammogram Back

3. What is your patient’s age? 45 and older Under 45 Back Back to Start

4. Is she uninsured or does she have insurance with a high deductible/co-pay that she cannot afford? Yes No Back Back to Start

5. Does her family make less than or equal to $29,425 plus $10,400 for each additional family member? Yes No Back Back to Start

6. Contact Kari Sievert of the Wisconsin Well Woman Program at (608)-242-6392 to discuss possible options. Back Back to Start

7. Is she eligible for any medical assistance programs such as BadgerCare, Medicaid or Medicare? Yes No Back Back to Start If you are unsure if you are eligible for Medicaid, please review the eligibility criteria here: https://www.dhs.wisconsin.gov/medicaid/index.htm https://www.dhs.wisconsin.gov/medicaid/index.htm

8. Medical assistance programs such as BadgerCare and Medicaid cover screening mammograms. If she eligible for these programs, she can enroll online at access.wi.gov, or by phone/mail by following instructions for her county of residence listed at https://www.dhs.wisconsin.gov/forwardhealth/imagency/index.htmaccess.wi.gov https://www.dhs.wisconsin.gov/forwardhealth/imagency/index.htm Back Back to Start

9. She may be eligible to receive breast services through the Treatment Access Fund. Services include: -Breast exam, ultrasound, MRI, mammogram, and biopsy -Office visits related to breast services -Breast Surgery Enroll by phone through the WWWP Program office: -(608) 242-6392 (for Spanish (608) 242-6235) Back Back to Start

10. Is she uninsured or have insurance with high deductibles or co-pays that she can’t afford? Yes No Back Back to Start

11. Her insurance covers a screening mammogram. The patient should contact her primary care provider to schedule an appointment. If she does not have a primary care provider, it is important for her to find out which providers her insurance will cover, and schedule an appointment. For more information on finding a provider, please see the link below: https://www.dhs.wisconsin.gov/guide/doctor.htm Back Back to Start

12. Does her family makes less than or equal to $29,425 plus $10,400 for each additional family member? Yes No Back Back to Start

13. Contact Kari Sievert of the Wisconsin Well Woman Program at (608)-242-6392 to discuss possible options. Back Back to Start

14. Your patient may be eligible to enroll in the Wisconsin Well Woman Program. Yes No Enroll : -By mail (form available at http://www.publichealthmdc.com/WWWP/documents/EnrollmentForm.pdf) http://www.publichealthmdc.com/WWWP/documents/EnrollmentForm.pdf -By phone through the WWWP Program office (608) 242-6392 (for Spanish (608) 242-6235 Has she been diagnosed with breast cancer? Back Back to Start

15. Wisconsin Well Woman Program will cover breast cancer screening. Back Back to Start

16. Is she a US citizen or an immigrant with qualifying immigrant status? Yes No Back Back to Start

17. Your patient may be eligible to enroll in Well Woman Medicaid. Services include: All Medicaid-covered services, not limited to breast cancer care Enroll by phone through the WWWP Program office: -(608) 242-6392 (for Spanish (608) 242-6235) Back Back to Start

18. Your patient may be eligible to receive breast services through the Treatment Access Fund. Services include: -Breast exam, ultrasound, MRI, mammogram, and biopsy -Office visits related to breast services Enroll by phone through the WWWP Program office: -(608) 242-6392 (for Spanish (608) 242-6235) Back Back to Start

19. Planned Parenthood provides these services. Appointments can be made by calling (608) 251-6546 (Madison South) or (608)241-3767 (Madison East) or online at: http://www.plannedparenthood.org/health-center/wisconsin/madison http://www.plannedparenthood.org/health-center/wisconsin/madison US citizens of childbearing age, making an individual income of $2942.50/month or less, and not receiving Medicaid/BadgerCare Plus are eligible to be enrolled in Family Planning Only Services (FPOS)- Planned Parenthood will enroll patients if they qualify and FPOS covers these services. Women who do not qualify for FPOS may be eligible to receive care at a reduced cost, depending on income. Back Back to Start

20. What is your patient’s age? 45 and older Under 45 Back Back to Start

21. Is she uninsured or does she have insurance with a high deductible/co-pay that she cannot afford? Yes No Back Back to Start

22. Your patient’s insurance covers a screening pap smear. She should contact her primary care provider to schedule an appointment. If she does not have a primary care provider, it is important for her to find out which providers her insurance will cover, and schedule an appointment. For more information on finding a provider, please see the link below: https://www.dhs.wisconsin.gov/guide/doctor.htm Back Back to Start

23. Does her family make less than or equal to $29,425 plus $10,400 for each additional family member? Yes No Back Back to Start

24. Planned Parenthood provides screening pap smears. Appointments can be made by calling (608) 251-6546 (Madison South) or (608)241-3767 (Madison East) or online at: http://www.plannedparenthood.org/health-center/wisconsin/madison http://www.plannedparenthood.org/health-center/wisconsin/madison Women may be eligible to receive care at a reduced cost, depending on income. Back Back to Start

25. Your patient may be eligible to enroll in the Wisconsin Well Woman Program. Yes No Enroll : -By mail (form available at http://www.publichealthmdc.com/WWWP/documents/enrollmentform.pdf ) http://www.publichealthmdc.com/WWWP/documents/enrollmentform.pdf -By phone through the WWWP Program office (608) 242-6392 (for Spanish (608) 242-6235 Has she been diagnosed with a pre-cancerous cervical condition or cervical cancer? Back Back to Start

26. Wisconsin Well Woman Program will cover cervical cancer screening. Back Back to Start

27. Is she a US citizen or an immigrant with qualifying immigrant status? Yes No Back Back to Start

28. Your patient may be eligible to enroll in Well Woman Medicaid. Services include: All Medicaid-covered services, not limited to breast cancer care Enroll by phone through the WWWP Program office: -(608) 242-6392 (for Spanish (608) 242-6235) Back Back to Start

29. If your patient has a pre-cancerous condition, she may be eligible to receive care through Share the Health Free Gynecology clinic Consider referring her to STH for a consultation. Referral form is available at http://www.sharethehealthwi.org/referring- provider-information.htmlhttp://www.sharethehealthwi.org/referring- provider-information.html Back Back to Start

30. Is she a US citizen or an immigrant with qualifying immigrant status? Yes No Back Back to Start

31. Is she uninsured or does she have insurance with a high deductible/co-pay that she cannot afford? Yes No Back Back to Start

32. Your patient’s insurance covers a screening pap smear. She should contact her primary care provider to schedule an appointment. If she does not have a primary care provider, it is important for her to find out which providers her insurance will cover, and schedule an appointment. For more information on finding a provider, please see the link below: https://www.dhs.wisconsin.gov/guide/doctor.htm Back Back to Start

33. Does her family make less than or equal to $29,425 plus $10,400 for each additional family member? Yes No Back Back to Start

34. Planned Parenthood provides screening pap smears. Appointments can be made by calling (608) 251-6546 (Madison South) or (608)241-3767 (Madison East) or online at:http://www.plannedparenthood.org/health- center/wisconsin/madisonhttp://www.plannedparenthood.org/health- center/wisconsin/madison Women may be eligible to receive care at a reduced cost, depending on income. Back Back to Start

35. Your patient may be eligible to enroll in Family Planning Only Services. Enroll online at access.wi.gov or by mail (form available at www.dhs.wisconsin.gov/forwardhealth/imagency - form F10182)access.wi.gov www.dhs.wisconsin.gov/forwardhealth/imagency Has she been diagnosed with a pre-cancerous cervical condition or cervical cancer? Yes No Back Back to Start

36. Family Planning Only Service will cover cervical cancer screening. Back Back to Start

37. Your patient may be eligible to enroll in Well Woman Medicaid. Services include: All Medicaid-covered services, not limited to breast cancer care Enroll by phone through the WWWP Program office: -(608) 242-6392 (for Spanish (608) 242-6235) Back Back to Start

38. Is she uninsured? Yes No Back Back to Start

39. Your Patient’s insurance covers a screening pap smear. She should contact her primary care provider to schedule an appointment. If she does not have a primary care provider, it is important for her to find out which providers her insurance will cover, and schedule an appointment. For more information on finding a provider, please see the link below: https://www.dhs.wisconsin.gov/guide/doctor.htm Back Back to Start

40. Does her family make less than or equal to $31,010 plus $12,180 for each additional family member? Yes No Back Back to Start

41. Planned Parenthood provides screening pap smears. Appointments can be made by calling (608) 251-6546 (Madison South) or (608)241-3767 (Madison East) or online at: http://www.plannedparenthood.org/health-center/wisconsin/madison http://www.plannedparenthood.org/health-center/wisconsin/madison Women may be eligible to receive care at a reduced cost, depending on income. Back Back to Start

42. Your patient may be eligible to receive care at Share the Health Free Gynecology Clinic Consider referring her to STH for a consultation. She must have a pap smear first. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Planned Parenthood can perform a pap smear. Women may be eligible to receive care at a reduced cost, depending on income. Appointments can be made online at http://www.plannedparenthood.org/health- centerwisconsin/madison or by phone at (608) 251-6546 (Madison South) or (608) 241-3767 (Madison East)http://www.plannedparenthood.org/health- centerwisconsin/madison Back Back to Start

43. Has she gone through menopause (≥1 year without a period)? Yes No Back Back to Start

44. Your patient may be eligible to receive care at Share the Health Free Gynecology Clinic, but needs a pelvic exam before being seen. Please perform a pelvic exam and then consider referring her to STH for a consultation. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html If you are not able to perform this exam, Planned Parenthood can. Appointments at Planned Parenthood can be made online at http://www.plannedparenthood.org/health-centerwisconsin/madison or by phone at (608) 251-6546 (Madison South) or (608) 241-3767 (Madison East) http://www.plannedparenthood.org/health-centerwisconsin/madison Back Back to Start

45. Please consider non-gynecologic causes of pelvic pain. Causes may include:  Gastrointestinal (constipation, irritable bowel syndrome, or inflammatory bowel disease)  Urinary (urinary tract infection)  Musculoskeletal Back Back to Start My patient’s pain is not due to the above-listed causes. My patient’s pain is not due to the above-listed causes.

46. Medical eligibility criteria for hormonal treatments is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5904a1.htm?s_cid=rr5904a1_e If this treatment does not improve your patient’s pain in 3-6 months, she may be eligible to receive care at Share the Health Free Gynecology clinic. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start Next, try ibuprofen as well as a hormonal treatment such as an oral contraceptive, progesterone IUD, or Depo Provera for 6 months.

47. Please Perform a pelvic exam and STI testing. Planned Parenthood can perform this exam/testing. Appointments at Planned Parenthood can be made online at http://www.plannedparenthood.org/health- centerwisconsin/madison or by phone at (608) 251-6546 (Madison South) or (608) 241-3767 (Madison East)http://www.plannedparenthood.org/health- centerwisconsin/madison Was a pelvic mass found on exam? Yes No Back Back to Start

48. Your patient may be eligible to receive care at Share the Health Free Gynecology Clinic Consider referring her to STH for a consultation. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start

49. Please consider non-gynecologic causes of pelvic pain. Causes may include:  Gastrointestinal (constipation, irritable bowel syndrome, or inflammatory bowel disease)  Urinary (urinary tract infection)  Musculoskeletal Then, try ibuprofen as well as a hormonal treatment such as an oral contraceptive, progesterone IUD, or Depo Provera for 6 months. Medical eligibility criteria for hormonal treatments is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5904a1.htm?s_cid=rr5904a1_e If this treatment does not improve your patient’s pain in 3-6 months, she may be eligible to receive care at Share the Health Free Gynecology clinic. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start

50. What is your patient’s age? 45 and older Under 45 Back Back to Start

51. Has she experienced on more than 1 occasion in the past year any of the following? - Bleeding that lasted > 7 days? - < 21 days from the start of 1 period to the start of the next? - Bleeding between periods or after sex? - More than 35 days between periods? Yes No Back Back to Start

52. Your patient does not meet diagnostic criteria for abnormal uterine bleeding. Back Back to Start

53. Has she had a pap smear within the past 3 years? Yes No Back Back to Start

54. Your patient may be eligible to receive care at Share the Health Free Gynecology Clinic Consider referring her to STH for a consultation. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start

55. Does she have insurance? Yes No Back Back to Start

56. Your patient’s insurance should cover evaluation for abnormal bleeding. She should contact primary care provider to schedule an appointment. If she does not have a primary care provider, it is important for her to find out which providers her insurance will cover, and schedule an appointment. For more information on finding a provider, please see the link below: https://www.dhs.wisconsin.gov/guide/doctor.htm Back Back to Start

57. Your patient may be eligible for a consult at Share the Health Free Gynecology Clinic, but she first needs a pap smear. Planned Parenthood can provide this if you cannot. Appointments at Planned Parenthood can be made online at http://www.plannedparenthood.org/health-centerwisconsin/madison or by phone at (608) 251-6546 (Madison South) or (608) 241-3767 (Madison East) http://www.plannedparenthood.org/health-centerwisconsin/madison US citizens of childbearing age, making an individual income of $2942.50/month or less, and notreceiving Medicaid/BadgerCare Plus are eligible to be enrolled in Family Planning Only Services(FPOS)- Planned Parenthood will enroll patients if they qualify and FPOS covers these services. Women who do not qualify for FPOS may be eligible to receive care at a reduced cost, depending on income. Consider referring her to Share the Health for a consult. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start

58. Has she gone through menopause (≥1 year without a period)? Yes No Back Back to Start

59. Has she experienced on more than 1 occasion in the past year any of the following? - Bleeding that lasted > 7 days? - < 21 days from the start of 1 period to the start of the next? - Bleeding between periods or after sex? - More than 35 days between periods? Yes No Back Back to Start

60. Your patient does not meet diagnostic criteria for abnormal uterine bleeding Back Back to Start

61. Has she had a pap smear within the past 3 years? Yes No Back Back to Start

62. Your patient may be eligible to receive care at Share the Health Free Gynecology Clinic Consider referring her to STH for a consultation. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start

63. Does she have insurance? Yes No Back Back to Start

64. Your patient’s insurance should cover evaluation for abnormal bleeding. She should contact her primary care provider to schedule an appointment. If she does not have a primary care provider, it is important for her to find out which providers her insurance will cover, and schedule an appointment. For more information on finding a provider, please see the link below: https://www.dhs.wisconsin.gov/guide/doctor.htm Back Back to Start

65. Does her family makes less than or equal to $29,425 plus $10,400 for each additional family member? Yes No Back Back to Start

66. You patient may be eligible to enroll in the Wisconsin Well Woman Program which will cover a pap smear. Enroll : -By mail (form available at http://www.publichealthmdc.com/WWWP/documents/enrollmentform.pdf) http://www.publichealthmdc.com/WWWP/documents/enrollmentform.pdf -By phone through the WWWP Program office (608) 242-6392 (for Spanish (608) 242-6235) After she has had a pap smear, she may be eligible to receive a consult at Share the Health Free Gynecology Clinic. Consider referring her to STH for a consultation. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start

67. Your patient may be eligible for a consult at Share the Health Free Gynecology Clinic, but she needs a pap smear first. Planned Parenthood can provide pap smears. Appointments at Planned Parenthood can be made online at http://www.plannedparenthood.org/health- centerwisconsin/madison or by phone at (608) 251-6546 (Madison South) or (608) 241-3767 (Madison East)http://www.plannedparenthood.org/health- centerwisconsin/madison US citizens of childbearing age, making an individual income of $2942.50/month or less, and notreceiving Medicaid/BadgerCare Plus are eligible to be enrolled in Family Planning Only Services(FPOS)- Planned Parenthood will enroll patients if they qualify and FPOS covers these services. Women who do not qualify for FPOS may be eligible to receive care at a reduced cost, depending onincome. Consider referring her to Share the Health for a consult. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start

68. Has she had any vaginal bleeding within the past year? Yes No Back Back to Start

69. Your patient does not meet diagnostic criteria for abnormal uterine bleeding Back Back to Start

70. Has she had a pap smear within the past 3 years? Yes No Back Back to Start

71. Your patient may be eligible to receive care at Share the Health Free Gynecology Clinic Consider referring her to STH for a follow-up consultation. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start

72. Does she have insurance? Yes No Back Back to Start

73. Your patient’s insurance should cover evaluation for abnormal bleeding. She should contact her primary care provider to schedule an appointment. If she does not have a primary care provider, it is important for her to find out which providers her insurance will cover, and schedule an appointment. For more information on finding a provider, please see the link below: https://www.dhs.wisconsin.gov/guide/doctor.htm Back Back to Start

74. Does her family makes less than or equal to $29,425 plus $10,400 for each additional family member? Yes No Back Back to Start

75. Your patient may be eligible to enroll in the Wisconsin Well Woman Program which will cover a pap smear. Enroll : -By mail (form available at http://www.publichealthmdc.com/WWWP/documents/enrollmentform.pdf) http://www.publichealthmdc.com/WWWP/documents/enrollmentform.pdf -By phone through the WWWP Program office (608) 242-6392 (for Spanish (608) 242-6235) After she has had a pap smear, she may be eligible to receive a consult at Share the Health Free Gynecology Clinic. Consider referring her to STH for a consultation. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start

76. Your patient may be eligible for a consult at Share the Health Free Gynecology Clinic, but she needs a pap smear first. Planned Parenthood can complete pap smears. Appointments at Planned Parenthood can be made online at http://www.plannedparenthood.org/health- centerwisconsin/madison or by phone at (608) 251-6546 (Madison South) or (608) 241-3767 (Madison East)http://www.plannedparenthood.org/health- centerwisconsin/madison US citizens of childbearing age, making an individual income of $2942.50/month or less, and notreceiving Medicaid/BadgerCare Plus are eligible to be enrolled in Family Planning Only Services(FPOS)- Planned Parenthood will enroll patients if they qualify and FPOS covers these services. Women who do not qualify for FPOS may be eligible to receive care at a reduced cost, depending onincome. Consider referring her to Share the Health for a consult. Referral form is available at http://www.sharethehealthwi.org/referring-provider- information.htmlhttp://www.sharethehealthwi.org/referring-provider- information.html Back Back to Start