NC WISEWOMAN Provider Manual and Forms

NC WISEWOMAN Program Manual

March 2023

For NC WISEWOMAN Providers

This training manual outlines guidelines, requirements and procedures for participating in North Carolina’s Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Program.

It is designed to provide important information on participant enrollment, program operations and program services. NC WISEWOMAN staff are available to assist you with any questions about the program. Contact us.

Get the full NC WISEWOMAN Program Manual

Provider Performance Evaluation Dashboard

Get a comprehensive view of your site's performance in our NC WISEWOMAN program. The dashboard is updated every two weeks using data entered in Med-IT.

Patient Forms

Forms in EnglishForms in Spanish
Consent Form - EnglishConsent Form - Spanish
Declination Form - EnglishDeclination Form - Spanish
Follow-up Screening Forms 4051A-E - EnglishFollow-up Screening Forms 4051A-E - Spanish
Healthy Behavior Support Services Form 4050A-B - EnglishHealthy Behavior Support Services Form 4050A-B - Spanish
Screening Forms 4049A-E - EnglishScreening Forms 4049A-E - Spanish
Validation FormN/A

Fees/Expenditures and More Resources

Shareable Materials

More Shareable Materials

Fact sheets, flyers, guides and journals, and more
Off