Department of Social Services
Family Support Division
PO Box 2320
Jefferson City, Missouri
TO: ALL FAMILY SUPPORT OFFICES
FROM: KIM EVANS, DIRECTOR
SUBJECT: REVISED BREAST AND CERVICAL CANCER TREATMENT MO HEALTHNET APPLICATION (IM-1BC)
FORM REVISION #
The IM-1BC is used by Show Me Healthy Women providers to assist participants applying for Breast and Cervical Cancer Treatment coverage.
The IM-1BC was revised to use updated terms and remove outdated information. The IM-1BC has a revision date of 10/2022. Providers should begin using the updated form with a 10/2022 revision date immediately, but outdated forms may still be accepted as valid applications through 1/31/2023.
The IM-1BC is available in the public and internal forms manuals.
- Review this memorandum with appropriate staff.
- Begin using the revised form (10/2022) immediately.
- Discard outdated forms.
- Provide updated form to community partners.