Think Pink All Year

December 20, 2023

Breast can­cer doesn’t fol­low a cal­en­dar — its impact is felt every sin­gle day of the year. That’s why the Illi­nois Breast and Cer­vi­cal Can­cer Pro­gram and the Han­cock Coun­ty Health Dept. are part­ner­ing with Quin­cy Med­ical Group to offer free mam­mo­grams to Illi­nois res­i­dents who have no health insur­ance or have high-deductible health insur­ance plans.

To find out if you qual­i­fy for the Illi­nois Breast and Cer­vi­cal Can­cer Pro­gram (IBC­CP), you will need to com­plete an enroll­ment pack­et. Our Quin­cy Med­ical Group team will be able to help you do that. To help you under­stand what is in the pack­et, below is a list of forms and iden­ti­fi­ca­tion you will need to bring with you to the Tues­day, Jan. 9 Think Pink All Year! Aware­ness event. If you are eli­gi­ble, you will be sched­uled for a mam­mo­gram on Tues­day, Jan. 23 at QMG at 1118 Hamp­shire St. in Quin­cy, IL.

  • Eli­gi­bil­i­ty Deter­mi­na­tion Form
  • Health Assess­ment Form
  • Cor­ner­stone Con­sent Form
    • This gives IBC­CP per­mis­sion to enter the infor­ma­tion you pro­vid­ed into the secure, con­fi­den­tial online sys­tem
      and allows IBC­CP to keep your breast and cer­vi­cal can­cer screen­ings up to date on an annu­al basis.
      Client Par­tic­i­pa­tion Form
  • Autho­riza­tion to Obtain Infor­ma­tion Form
  • Joint Notice of Pri­va­cy Prac­tices & Consent
  • Please include the fol­low­ing with your enroll­men­t/re-enroll­ment packet:
    • Income ver­i­fi­ca­tion (2 most recent pay­check stubs or recent 1040 tax forms)
    • Age ver­i­fi­ca­tion (driver’s license copy, ID card, or birth certificate)
    • Med­ic­aid ver­i­fi­ca­tion (copy of your card)
    • Insur­ance ver­i­fi­ca­tion (copy of the front & back of your card
  • For more infor­ma­tion, contact: