NBCCEDP Clinic-Level Data Instrument (Screenshots)

Att 6a - NBCCEDP Clinic-Level Data Collection Instruments (screenshots).docx

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

NBCCEDP Clinic-Level Data Instrument (Screenshots)

OMB: 0920-1046

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NBCCEDP Clinic-Level Data Instrument (Screenshots)





Welcome Screen

Navigation



Health System Data





Health System Data – Baseline





Health System Data – Annual



Clinic Data - Characteristics



Clinic Data – Baseline Breast

Clinic Data – Baseline Breast (continued)

Clinic Data – Baseline Breast (continued)



Clinic Data – Baseline Breast (continued)



Clinic Data – Baseline Breast (continued)

Clinic Data – Baseline Breast (continued)

Clinic Data – Baseline Breast (continued)



Clinic Data – Baseline Breast (continued)



Clinic Data – Baseline Breast (continued)



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 – Baseline Cervical (continued)



Clinic Data – Baseline Cervical (continued)



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)

Clinic Data – Annual Cervical (continued)



Clinic Data – Annual Cervical (continued)

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