VCS PATHOLOGY OFFERS SUPPORT FOR CERVICAL SCREENING WITH TELEHEALTH
Providing Cervical Screening Services Across Australia
VCS Pathology is now offering to send home self-sampling kits to eligible women in order to assist clinicians in screening asymptomatic women that are identified as UNSCREENED or UNDERSCREENED during a Telehealth consultation. To provide this service the following guidelines apply:
• overdue for cervical screening by two years or longer (i.e. four years or more since their last Pap test), or
As with all laboratory tests the results will be sent to you for your records and follow up.
• have never screened. Simply follow the step-by-step instructions below:
1
2
SWAB:
POSITION:
• Remove the swab out of its plastic tube, just twist and pull it • If possible, avoid taking the sample during your monthly period
• Undress from the waist down • Get into a comfortable position as shown above while holding the swab in your hand
4
5
TAKING THE SAMPLE:
TAKING THE SAMPLE (continued):
• Gently spread open the folds of skin at the vaginal opening with your other hand • Insert the swab into your vagina directed towards your lower back about two inches (5cm), half the length of a finger. This is similar to how you would insert a tampon
• Rotate the swab gently for 10-30 seconds
RETURN TO PLASTIC TUBE: • Place the swab into the plastic tube • Tightly screw the cap onto the tube • Finish by washing your hands with soap and water
WHAT DOES THE KIT CONTAIN? • • • •
A swab in a plastic tube A plastic ziplock bag This instruction sheet The request form provided by your health professional • A padded ‘Reply paid’ envelope
265 Faraday PO Box 178 St Carlton South P: 03 9250 Carlton South VIC VIC 3053 0300 F: 03 3053 9349 1949
Patient Surname
MEDICARE
CARD NUMBER
Given Names
Patient Address
PATHOLOGY
Gender
Date of Birth
Previous Surname
CST Follow up HPV tests L.B.C only
Co-test (indication)*
(indication)*
ng
Is the patient Torres Strait of Aboriginal or Islander origin?
BIOLOGICAL SUBSTANCES CATEGORY B
Do not send
to My Health
Urgent Phone Phone/Fax No. Private Schedule Vet Affairs No.
COPY REPORTS
was the patient
Record
(Complete
No
of cervix
Medicare Assignment)
TO:
Practition
X
Yes (specify)
Normal Abnormal
(specify)
Cervix
Other
partum
(specify)
Hysterectomy
CST taken by nurse Practitioner requesting No. if not practitioner
IUCD Same day colposcopy
By Time:
Bulk Bill
LAB COPY
where appropriate
bleeding
site
Pregnant/Post
(please specify)
Fax
Abnormal
Appearance
Specimen
born?
Does the patient speak a English at home? (If morelanguage other than indicate the than one language, one that is spoken most No, English often) only Yes, other
er’s Signa ture Request D ate
Requesting
MEDICARE ASSIGNMENT
Practitioner (Provider number, Surname, Initials and (Section 20A of the Health Insurance approved pathology practitioner Act 1973). I assign my right to who will render Practitioner only (please the requested benefits to the tick). Reason pathology service(s) patient unable to sign.
Complete patient name and date of to attaching birth prior PLACE LABEL specimen. If more than VERTICALLY write patient 3 specimens details on additional specimens
Date
Date Name DOB
Patient’s Signature
Patient Ad dress
Tests Requested
Patient status or when the at the time of the specimen was service collected
Private patient or approved in a private hospital day hospital Private patient in a recognised hospital A public patient in a recognised hospital Outpatient of a recognised hospital
Name DOB
Birth
Telephone
Requesting
MEDICARE
NUMBER
Your Reference
T CO PY
Privacy Note: administrationThe information Health Insuranceof government provided will be used health programs, to assess Act 1973. associated and may be any Medicare benefit with this claim, The information payable for or as authorised may be disclosedused to update enrolment the to the Department by law. records. Its services rendered and collection of Health is authorised to facilitate the proper and Ageing Patient status by provisions or to a person of the in the medical the specimen at the time of the practice service or was collected when Private patient in a private hospital or Yes No Private patient approved day in a recognised hospital A public patient hospital in a recognised (Section 20A Outpatient hospital of the Health of a recognised Insurance Act I assign my hospital
practitioner
Yes No
/ /
Date
Date
Name DOB
Your doctor The Royal College Pathologists Accredited pathologist has recommended for of Australasia that you use on clinical with NPAAC compliance MEDICARE grounds, Standards a Medicare VCS Pathology. You CARD and ISO 15189 are free to rebate will choose your only be payable Given Names if that pathologistown pathology provider. performs the service. However, if your doctor You should discuss this has specified a particular Gender with your doctor. Date of
PAT IEN
*
/ / Address)
X
Date
Name DOB
265 Faraday PO Box 178 St Carlton South VIC 3053 P: 03 9250 Carlton South VIC 3053 0300 F: 03 9349 1949
Patient Surname
3
Tick only
Aboriginal
Torres Strait Islander Aboriginal and Torres Strait Islander Not Aboriginal or Torres Strait Islander
In which country
Date
Emergency Contact Numbers: Business hours: (03) 9250 0300 After hours: 0427 308 373
delines:Cervical_cancer/Screeni
Clinical Notes
UN3373
REQUEST
Your Reference
Tests Requested
*Ref: wiki.cancer.org.au/australia/Gui
VCS PATHOLOGY Reply Paid 178 CARLTON SOUTH VIC 3053
Name
Self-collection must be requested and facilitated by a practitioner who also offers routine cervical screening services.
INSTRUCTIONS
HOW TO SELF COLLECT AN HPV TEST
DOB
The patient should be asked whether they are willing and able to come into the practice for a conventional cervical screening test. If declined, then self-collection can be offered.
ASSIGNMENT
right to benefits 1973). who will render to the approved pathology the requested pathology service(s)
(Home)
Practitioner
Telephone
(Provider number,
(Business)
Surname, Initials
and Address)
© VCS Foundation Ltd. 2020
Self-collection of a vaginal sample is available for patients aged 30 years or over, who have declined to have a cervical sample collected by a clinician, and are either:
On receipt of the request form we will confirm eligibility with the NCSR and then send a home self-collection kit to the woman’s preferred address. If there are any apparent issues with eligibility, we will call you or your practice to clarify.
Patient’s Signature
X
Date
/ / Path_Pub_3
V9
• There should be no pain or discomfort
* This image is adapted from Garrow SC et al. The diagnosis of chlamydia, gonorrhoea, and trichomonas infections by self-obtained low vaginal swabs in remote northern Australian clinical practice. Sex Transm Infect. 2002 Aug; 78 (4):278-81
If your patient qualifies: Send VCS Pathology a Request Form indicating “Home Self Sampling Kit” in the tests requested section. Please ask the patient for their preferred address.
>> Instructions overleaf on how to pack and post the sample...
• Leave the request form for collection by our couriers or - Send by Fax (03) 9349 1977 or - Mail: PO Box 178 Carlton South, Victoria 3053 If you would like to discuss this option further, please contact: VCS Pathology on (03) 9250 0300
www.vcspathology.org.au
Corp-Mkt-Pub 147 V1
Corp-Mkt-Pub-146 V1
Does the woman qualify for self-collection?