Screen shots of the Clinic Baseline and Annual Reporting

National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Monitoring Activities

Att 7_NBCCEDP Clinic-Level Data Collection Instrument

Clinic-level Cervical Cancer Screening Data

OMB: 0920-1046

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ATTACHMENT 7: NBCCEDP Clinic-Level Data Instrument (Screenshots)


Prepared with “dummy” data





Welcome Screen

Health System Data

Clinic Data - Characteristics



Clinic Data – Characteristics, continued











Clinic Data – Characteristics, continued







Clinic Data – Baseline Breast

















Clinic Data – Baseline Breast, continued



Clinic Data – Baseline Breast, continued

















Clinic Data – Baseline Breast, continued





Clinic Data – Annual Breast

Clinic Data – Annual Breast, continued























Clinic Data – Annual Breast, continued



Clinic Data – Annual Breast, continued



Clinic Data – Annual Breast, continued

Clinic Data – Annual Breast, continued



Clinic Data – Annual Breast, continued

















Clinic Data – Annual Breast, continued



































Clinic Data – Annual Breast, continued





















Clinic Data – Baseline Cervical

















Clinic Data – Baseline Cervical, continued











Clinic Data – Baseline Cervical, continued















Clinic Data – Baseline Cervical, continued











Clinic Data – Annual Cervical















Clinic Data – Annual Cervical, continued























Clinic Data – Annual Cervical, continued







Clinic Data – Annual Cervical, continued







Clinic Data – Annual Cervical, continued

Clinic Data – Annual Cervical, continued



Clinic Data – Annual Cervical, continued

















Clinic Data – Annual Cervical, continued



































Clinic Data – Annual Cervical, continued

Attachment 7 – NBCCEDP Clinic-Level Data Collection Instrument (Screenshots) Page 17 of 17

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorHowe, Will (IMS)
File Modified0000-00-00
File Created2021-01-20

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