Screening Coordinator Resources

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PCCNC Referral Discussion Guide
If you are concerned about referral, please share this discussion guide with your patients.

PCEC Partnership Oppotunity.
The following resources are intended to help build evidence and support for promoting the possibly life saving early detection of prostate cancer via prostate screening.

• PCEC Prostate Screening Program Guide (3,371KB-PDF)
• PCEC Longitudinal Research Site Guide (6,629KB-PDF)

• Screening Site Registration Form (86KB-PDF)
• Screening Supplies Order Form (114KB-PDF)

• Participant Informed Consent and Waiver for Screening (38KB-MS WORD)
• Sample Consent Form (148KB-MS WORD)
• Authorization Form (118KB-MS WORD)
• Screening Questionnaire (818KB-PDF)
• Screening Questionnaire plus Program Detail (2,808KB-PDF)

• Recommended Follow-up Ater Participation in Prostate Cancer Awareness Week Screening (143KB-PDF)
• Normal Range Follow-up Form Letter (31KB-MS WORD)
• Final Report Form (79KB-PDF)

The information and opinions expressed on this web site are not an endorsement or recommendation for any medical treatment, product, service or course of action by the Prostate Cancer Coalition of North Carolina or its officers and directors. For medical, legal or other advice, please consult appropriate professionals of your choice.