Follow the steps to effectively complete the form

1. Press the ‘Get Form’ button to obtain the PEEHIP HCP Screening Form and access it for completion.
2. Begin with Section 1, to be completed by the active or retired employee or their partner. Fill in your contract number, and ensure to print clearly using a black ink pen.
3. Complete the social security number (SSN) of the individual being screened, followed by the screening date. Remember to darken the boxes completely where required.
4. Indicate the birth date and select the appropriate option for gender by darkening the corresponding box for either 'Male' or 'Female'.
5. Provide a daytime phone number as well as the last and first name of the person being screened.
6. If the screening was not performed due to pregnancy or any other reason, please specify that in the provided sections.
7. Select your race/ethnicity from the options provided by completely darkening the respective box.
8. Indicate if you have been diagnosed with conditions such as high cholesterol, high blood pressure, or diabetes and whether you take medication for these conditions.
9. Section 2 is to be completed by your healthcare provider. They will fill out important health information including blood pressure, blood glucose, total cholesterol, height, weight, and waist measurements.
10. Your healthcare provider will also need to ask if you have used a tobacco product in the last 12 months and sign the form.
11. After completing the form, ensure all information is accurate. Save any changes made, and then download, print, or share the completed form as necessary.

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