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

2. What is your concern? I need a pap smear or follow up after an abnormal pap smear. I need birth control or STD testing, treatment or vaccines I am having problems with vaginal bleeding I am having pelvic pain I need a mammogram Back

3. What is your age? 45 and olderUnder 45 Back Back to Start

4. Are you uninsured or do you have insurance with a high deductible/co-pay that you cannot afford? YesNo Back Back to Start

5. Does your family make less than or equal to $29,425 plus $10,400 for each additional family member other than you? YesNo 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. Are you eligible for any medical assistance programs such as BadgerCare, Medicaid or Medicare? YesNo 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.htmhttps://www.dhs.wisconsin.gov/medicaid/index.htm

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

9. You 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. Are you uninsured or have insurance with high deductibles or co-pays that you can’t afford? YesNo Back Back to Start

11. Your insurance covers a mammogram. Please contact your primary care provider to schedule an appointment. If you do not have a primary care provider, it is important to find out which providers your 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 your family makes less than or equal to $29,425 plus $10,400 for each additional family member other than you? YesNo 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. You may be eligible to enroll in the Wisconsin Well Woman Program. YesNo 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) Have you been diagnosed with breast cancer? Back Back to Start

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

16. Are you a US citizen or an immigrant with qualifying immigrant status? YesNo Back Back to Start

17. You 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. You 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 age? 45 and olderUnder 45 Back

21. Are you uninsured or do you have insurance with a high deductible/co-pay that you cannot afford? YesNo Back Back to Start

22. Your insurance covers a pap smear. Please contact your primary care provider to schedule an appointment. If you do not have a primary care provider, it is important to find out which providers your 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 your family make less than or equal to $29,425 plus $10,400 for each additional family member other than you? YesNo Back Back to Start

24. Planned Parenthood provides 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. You may be eligible to enroll in the Wisconsin Well Woman Program. YesNo 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 Have you had an abnormal pap smear or been diagnosed with cervical cancer? Back Back to Start

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

27. Are you a US citizen or an immigrant with qualifying immigrant status? YesNo Back Back to Start

28. You 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 you have an abnormal pap smear you may be eligible to receive care through Share the Health Free Gynecology clinic Ask your doctor to consider referring you to STH for a consultation. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html If you do not have a doctor, please make an appointment at Planned Parenthood to see a provider that may be able to refer you to Share the Health. Appointments can be made online at http://www.plannedparenthood.org/health- centerwisconsin/madison http://www.plannedparenthood.org/health- centerwisconsin/madison Back Back to Start

30. Are you a US citizen or an immigrant with qualifying immigrant status? YesNo Back Back to Start

31. Are you uninsured or do you have insurance with a high deductible/co-pay that you cannot afford? YesNo Back Back to Start

32. Your insurance covers a screening pap smear. Please contact your primary care provider to schedule an appointment. If you do not have a primary care provider, it is important to find out which providers your 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 your family make less than or equal to $29,425 plus $10,400 for each additional family member other than you? YesNo Back Back to Start

34. Planned Parenthood provides 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

35. You 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) www.dhs.wisconsin.gov/forwardhealth/imagency Have you had an abnormal pap smear or been diagnosed with cervical cancer? YesNo Back Back to Start

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

37. You 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. Are you uninsured? YesNo Back Back to Start

39. Your insurance covers a pap smear. Please contact your primary care provider to schedule an appointment. If you do not have a primary care provider, it is important to find out which providers your 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 your family make less than or equal to $31,010 plus $12,180 for each additional family member other than you? YesNo Back Back to Start

41. Planned Parenthood provides 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

42. You may be eligible to receive care at Share the Health Free Gynecology Clinic Ask your doctor to consider referring you to STH for a consultation. You must a have pap smear first. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html If you do not have a doctor, please make an appointment at Planned Parenthood to see a provider who will complete your pap smear and refer you to Share the Health. 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. Have you gone through menopause (≥1 year without a period)? YesNo Back Back to Start

44. You may be eligible to receive care at Share the Health Free Gynecology Clinic, but you need a pelvic exam and STI/ pregnancy testing first Please see your doctor or a provider at Planned Parenthood for a pelvic exam, pregnancy test, and STD testing. After these tests have been completed, ask your doctor to consider referring you to STH for a consultation. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html Back Back to Start

45. Your doctor may consider non- gynecologic causes of pelvic pain. These causes may include:  Gastrointestinal causes like constipation, irritable bowel syndrome, or inflammatory bowel disease  Urinary causes like a urinary tract infection  Musculoskeletal causes like tight muscles If your doctor rules out these other causes, they may have you try medicines such as ibuprofen and birth control for 6 months. If this treatment does not improve your pain, you may be eligible to receive care at Share the Health Free Gynecology clinic. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html Back Back to Start

46. Please see your doctor or a provider at Planned Parenthood for a pelvic exam and STD 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 during your pelvic exam? YesNo Back Back to Start

47. You may be eligible to receive care at Share the Health Free Gynecology Clinic Ask your doctor to consider referring you to STH for a consultation. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html Back Back to Start

48. Your doctor may consider non- gynecologic causes of pelvic pain. These causes may include:  Gastrointestinal causes like constipation, irritable bowel syndrome, or inflammatory bowel disease  Urinary causes like a urinary tract infection  Musculoskeletal causes like tight muscles If your doctor rules out these other causes, they may have you try medications such as ibuprofen and birth control for 3 months. If this treatment does not improve your pain, you may be eligible to receive care at Share the Health Free Gynecology clinic. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html Back Back to Start

49. What is your age? 45 and olderUnder 45 Back Back to Start

50. Have you 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? YesNo Back Back to Start

51. Your bleeding may be normal. Please discuss this with your doctor. Back Back to Start

52. Have you had a pap smear within the past 3 years? YesNo Back Back to Start

53. You may be eligible to receive care at Share the Health Free Gynecology Clinic Ask your doctor to consider referring you to STH for a consultation. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html If you do not have a doctor, please make an appointment to see a provider at Planned Parenthood. 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

54. Do you have insurance? YesNo Back Back to Start

55. Your insurance should cover evaluation for abnormal bleeding. Please contact your primary care provider to schedule an appointment. If you do not have a primary care provider, it is important to find out which providers your 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

56. You may be eligible for a consult at Share the Health Free Gynecology Clinic, but you need a pap smear. Planned Parenthood can provide this. 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 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. Ask the provider at Planned Parenthood to consider referring you to Share the Health for a consult. Referral form (for use the provider) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html Back Back to Start

57. Have you gone through menopause (≥1 year without a period)? YesNo Back Back to Start

58. Have you 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? YesNo Back Back to Start

59. Your bleeding may not be abnormal. Please contact your doctor if you have additional concerns. Back Back to Start

60. Have you had a pap smear within the past 3 years? YesNo Back Back to Start

61. You may be eligible to receive care at Share the Health Free Gynecology Clinic Ask your doctor to consider referring you to STH for a consultation. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html If you do not have a doctor, please make an appointment to see a provider at Planned Parenthood. 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 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

62. Do you have insurance? YesNo Back Back to Start

63. Your insurance should cover evaluation for abnormal bleeding. Please contact your primary care provider to schedule an appointment. If you do not have a primary care provider, it is important to find out which providers your 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

64. Does your family makes less than or equal to $29,425 plus $10,400 for each additional family member other than you? YesNo Back Back to Start

65. You 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 you have had a pap smear, you may be eligible to receive a consult at Share the Health Free Gynecology Clinic. Ask your doctor to consider referring you to STH for a consultation. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html Back Back to Start

66. You may be eligible for a consult at Share the Health Free Gynecology Clinic, but you need a pap smear. Planned Parenthood can provide this. 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 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. Ask the provider at Planned Parenthood to consider referring you to Share the Health for a consult. Referral form (for use the provider) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html Back Back to Start

67. Have you had any vaginal bleeding within the past year? YesNo Back Back to Start

68. You are not experiencing abnormal bleeding. Please contact your doctor if you have additional concerns. Back Back to Start

69. Have you had a pap smear within the past 3 years? YesNo Back Back to Start

70. You may be eligible to receive care at Share the Health Free Gynecology Clinic Ask your doctor to consider referring you to STH for a consultation. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html If you do not have a doctor, please make an appointment to see a provider at Planned Parenthood. 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 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

71. Do have insurance? YesNo Back Back to Start

72. Your insurance should cover evaluation for abnormal bleeding. Please contact your primary care provider to schedule an appointment. If you do not have a primary care provider, it is important to find out which providers your 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

73. Does your family makes less than or equal to $29,425 plus $10,400 for each additional family member other than you? YesNo Back Back to Start

74. You 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 you have had a pap smear, you may be eligible to receive a consult at Share the Health Free Gynecology Clinic. Ask your doctor to consider referring you to STH for a follow-up consult or procedure. Referral form (for use by your doctor) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html Back Back to Start

75. You may be eligible for a consult at Share the Health Free Gynecology Clinic, but you need a pap smear. Planned Parenthood can provide this. 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 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. Ask the provider at Planned Parenthood to consider referring you to Share the Health for a consult. Referral form (for use the provider) is available at http://www.sharethehealthwi.org/referring-provider-information.html http://www.sharethehealthwi.org/referring-provider-information.html Back Back to Start