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: