Forms, reference documents and reports for use in the CervicalCheck cervical screening programme.
Forms for GP practices and clinics
Cervical Screening Form (consent form)
Cervical screening form (PDF, 3 pages, 500KB) - this consent form includes an information sheet so that a person can make informed consent
Colposcopy Referral Form
Colposcopy referral form (PDF, 1 page, 308KB) -use this form when making a referral to colposcopy
Hysterectomy
Hysterectomy data collection form (PDF, 1 page, 200KB) - for women who have had total abdominal hysterectomies and do not need future cervical screening
Cervical Screening Not Advised
Cervical screening not advised (PDF, 1 page, 120KB) - for when a person no longer needs to be called for regular cervical screening
Guidance notes
You can find guidance notes for cervical screening sample takers here.
Reference documents
How to complete the cervical screening form (PDF, 1 page, 190KB) - this form is designed to help those working in primary care for GP’s and Practice nurses
How to complete the cervical screening form STI/GUM (PDF, 1 page, 190KB) - this form is designed to help those working in Genito-Urinary Medicine such as sexual health, HIV and sexually transmitted infections clinics
How to complete the cervical screening form Gynae (PDF, 1 page, 190KB) - this form is designed to help those working in secondary care/ gynaecology outpatient clinics who may be performing cervical screening
How to complete the cervical screening form Oncology (PDF, 1 page, 190KB) - this form is designed to help those working in oncology who may be performing cervical screening
Checklist for cervical screening STI/GUM (PDF, 2 pages, 225KB) - this checklist to help those working in Genito-Urinary Medicine such as sexual health, HIV and sexually transmitted infections clinics when preparing to take a cervical screening test
Cervical screening test
Eligibility framework for cervical screening (PDF, 1 page, 150KB) - reference guide for GPs and sample takers to check if a person is eligible for a screening test
HPV Primary Screening Algorithm (PDF, 1 page, 115KB) - description of referral pathways
Desktop guide - information sheet to support doctors and nurses with HPV cervical screening (You will need login details for National Screening Services Resources website to access this document)
Results recommendation guidance
Cervical screening results and recommendation table (PDF, 1 page, 200KB) - describes the management recommendations provided by the pathology laboratory
Cervical screening results and management recommendations guide (PDF, 10 page, 450KB) - comprehensive guide on the management recommendations of a person based on their results.
Cytology Terminology Table (PDF, 1 page, 220KB) - Recommendations for management of person based on their screening test results
Colposcopy algorithms
Colposcopy Algorithm 1 Management of people with HR-HPV positive & normal or low grade abnormal cytology
Colposcopy Algorithm 2 Management of people with HR-HPV positive and high grade abnormal cytology or any glandular abnormality (including Atypical Glandular Cells)
Colposcopy Algorithm 3 Colposcopy Management of people for Test of Cure following treatment of CIN
Colposcopy Algorithm 4 Colposcopy Management of people for Test of Cure following complete excision of CGIN/SMILE
Colposcopy Algorithm 5 Conservative Management of histologically confirmed CIN 2
CervicalCheck programme reports
Multilingual CervicalCheck information videos - for participants and healthcare professionals
CervicalCheck - HPV cervical screening - English
Rastreio cervical / HPV cervical screening - Portuguese
Badania przesiewowe szyjki / HPV cervical screening - Polish
حص عنق الرحم فحص / HPV cervical screening - Arabic
Testul de evaluare cervicală HPV /HPV cervical screening - Romanian
La Prueba de Detección del VPH en el Cuello Uterino /HPV cervical screening - Spanish
Скрининг шейки матки/ HPV cervical screening - Russian
Le frottis cervical de dépistage /HPV cervical screening - French
رویکل اسکر سرویکل / HPV cervical screening - Urdu
HPV gimdos kaklelio patikrinimo testą / HPV cervical screening - Lithuanian
Dzemdes Kakla Skrīnings / HPV cervical screening - Latvian
Cervikálny skríning, na HPV / HPV cervical screening - Slovak
Àlàyé nípa síṣe àyèwò akàn ilé-ọmọ fún kòkòrò HPV/HPV Cervical Screening - Yoruba
Taarifa kuhusu upimaji wa virusi vya HPV kwenye shingo ya uzazi/HPV Cervical Screening - Swahili
INFORMACION PËR KONTROLLIN E QAFËS SË MITRËS , HPV/HPV Cervical Screening - Albanian
Informacija o probiru HPV-a vrata maternice/HPV Cervical Screening - Croatian
Macluumadka Baaritaanka Ilmo- galaynka ee HPV/HPV Cervical Screening - Somali
HPV 宫颈筛查信息/HPV Cervical Screening - Mandarin
সার্ভিকাল ক্যান্সারের স্ক্রিনিং বিষয়ে /HPV Cervical Screening in Bengali