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Certificate of diagnosis 2026
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- Click ‘Get Form’ to open the certificate of diagnosis in the editor.
- Begin by entering the client’s name and Social Security Number (SSN) in the designated fields at the top of the form.
- Next, specify the BCCSP Screening Clinic where the diagnosis was made, followed by the date of diagnosis.
- In the section for Breast or Cervical Diagnosis, check one option under either 'Breast' or 'Cervical' that corresponds to the patient's condition. Ensure you select only one diagnosis.
- After selecting a diagnosis, have the physician sign and date in the provided signature area. The physician's name and contact information should also be filled out accurately.
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