STATE OF MARYLAND



STATE OF MARYLAND

DHMH

Maryland Department of Health and Mental Hygiene

201 W. Preston Street • Baltimore, Maryland 21201

Martin O’Malley, Governor – Anthony G. Brown, Lt. Governor -- Joshua M. Sharfstein, M.D., Secretary

Family Health Administration

Donna Gugel, Acting Director

CCSC HOM #12-20

MEMORANDUM

To: Health Officers

CRF/CPEST Program Directors, Coordinators, and Staff

SAHC Program Directors, Coordinators, and Staff

From: Barbara Andrews

Program Manager, Cigarette Restitution Fund Programs Unit, CCSC

Date: May 11, 2011

Subject: Spanish Translation of the CRF CPEST Consent Form

______________________________________________________________________________

As requested, we have obtained a Spanish translation of the Long Form Consent for the Cigarette Restitution Fund (CRF), Cancer Prevention, Education, Screening, and Treatment (CPEST) Program. See attached. This document can be modified for your program to be consistent with your programs offering colorectal, prostate, skin, and/or oral cancer screening. This translation is consistent with the consent in English that we provided in Health Officer Memo #11-42, November 21, 2011.

Additionally, attached is the Breast and Cervical Cancer Program Spanish consent. This form is also available on the BCCP website at .

If you have any questions, please feel free to contact me at 410-767-5123 or bandrews@dhmh.state.md.us

Attachments (e-mailed to Health Officers and CRF Coordinators)

cc: Donna Gugel, Kelly Sage

Courtney Lewis, Sarah Hokenmaier

Diane Dwyer, M.D., Carmela Groves

File

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