Please complete this colorectal cancer test kit! You do the kit in your own home.

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1 Please complete this colorectal cancer test kit! You do the kit in your own home. What is Colorectal Cancer? Colorectal cancer is cancer in the colon or rectum. In most people, colon cancer develops slowly over many years. It is most often found in people aged 50 years or older. Who should get screened for colon cancer? You should get screened if you are 50 to 75 years old. Both men and women should be screened. People of all races need to be screened. Screening for colon cancer saves lives. Screening can find problems that can turn into cancer. If found early, colon cancer can often be treated and cured. Is there a simple screening test I can do at home? Yes! One way to get screened is to use a home test kit. This kit is some times called an ifobt kit. This kit checks for blood in your stool (feces). You only need to do one sample. Then you mail the sample to a lab. The lab sends the result back to you in a sealed envelope. The lab sends the results to your doctor. Gateway is giving you a home test kit at no charge to you. You send your sample to the lab. The lab sends test results to you and to your assigned doctor. If you want your results sent to a different doctor, call us at and tell us. It is up to you to call your doctor if you have questions about your results. Gateway cares about you. We want you to be in control of your health. Please do this screening test as soon as possible. Thank you! Michael Madden, MD, Chief Medical Officer See the next pages for instructions on how to use the kit. Gateway Health Plan is a Coordinated Care plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. Gateway Health Plan is a Coordinated Care plan with a Medicare contract.

2 FIRST - Collect your stool sample Unfold the special tissue paper. Lay it on top of the water in your toilet bowl. It will float. Deposit your stool sample on top of that tissue paper. Open the plastic sampling bottle by pulling off the green cap. A green wand is attached to the cap. Pull it out of the bottle. Scrape your stool sample with the probe end of the green wand. Cover the grooved portion of end of the wand with the stool sample. Slide the wand back into the plastic sampling bottle. Snap the cap on tightly. Do not reopen. Write your name on the lines on outside of the tube. Write your date of birth (DoB) and the date you perform the test on the tube. Flush the toilet. The special tissue paper will flush down with the toilet water. You do not need to touch the tissue paper or take it out of the toilet.

3 SECOND Wrap your sample to send it to the lab Wrap the small piece of packing paper around the plastic sampling bottle that now contains your sample. Place the wrapped tube in the plastic Biohazard baggie. Seal the baggie. Put the sealed baggie with its contents into the cardboard mailing envelope. Keep the sample at room temperature until you mail it. Do not refrigerate it.

4 THIRD Fill out 3 things on the Test Requisition Form. Take out the Test Requisition Form. It looks like this: Go to where it says Collection Time and Collection Date. It s shown here in yellow. Write in the time and the date when you collected your stool sample. Go to where it asks for your signature. Sign your name above where it says Patient Signature. Write the date next to your signature. Fold up the Test Requisition Form. Put it into the cardboard mailing envelope.

5 FOURTH Mail it all to the lab! Check to make sure the following are in the cardboard envelope: The wrapped up plastic tube The completed Test Requisition Form Peel tape off the flap of the cardboard mailing envelope. Fold envelope flap at pre-fold line. Press down to seal the envelope. Mail the sealed cardboard mailing envelope in the U.S. Mail. You must mail the sample within 24 hours of collecting it. Mail the sealed envelope in a regular mailbox or by dropping it off at the post office. ** You must mail the sample within 24 hours of collecting it. ** Need more information? Please call Gateway at: TTY/TDD: En español: , #6