AMIGAS Contact Sheet
The contact sheet is available in Microsoft Word [DOCX-65KB] and PDF [PDF-123KB] formats.
The contact sheet is a form for you to use to keep track of every woman you speak with about cervical cancer screening. This is for both individual and group AMIGAS sessions. The personal information at the top of this form lets you know where a woman was in her decision to get a screening test when you first spoke with her. You can use this information and any notes you write about subsequent conversations to help each woman move closer toward getting screening tests regularly.
Note: If you collect contact information electronically, you can use the contact sheet as a guide for useful information to collect.
How to Use the Contact Sheet
To complete the contact sheet—
- At the end of every session, ask each participant to complete the information at the top of the contact sheet.
- The second half of the page is for you to complete. The first two lines of the Follow-up section can be completed before, during, or immediately after the session. The remainder is for later conversations.
- When you follow up with each woman after a session, take notes at the bottom of the page. Include the date and details of the conversation, such as whether the woman is ready to get screened and why, what steps she has taken to get screened, and whether she has made a screening test appointment. If she has made an appointment, include the date of the appointment so you can follow up with her again after that date to find out how the test went. If she has had the test, record how the test went for her and if she has received the results. Make a note of any problems the woman might be having in getting her screening test so you know how you can help her.
Things to remember—
- It is important to have every woman complete a contact sheet (or provide similar information electronically).
- The contact sheet should serve as a useful tool for you to understand each woman’s particular situation and how you can help her get screening tests.
- The contact sheet is for you and your program to use. It is not for women to take home.