Get Physician Results Form To Update No Smoking 8.5.13 Origional.doc

Filling out the Physician Results Form To Update No Smoking 8.5.13 Origional.doc online is a straightforward process that ensures your health data is accurately reported. This guide will walk you through each section of the form, providing clear instructions to facilitate completion.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the Physician Results Form. This action will open the document in your preferred online editor, allowing you to begin filling it out.
2. In the first section labeled 'Wellness Participant Completes,' enter the participant's name in the format of Last, First, and Middle Initial, ensuring correct spelling. Then, provide the email address, date of birth using the MM/DD/YYYY format, unique ID, phone number, and residential address including city, state, and zip code.
3. Next, the wellness participant must sign in the designated field and include the date of the signature. This step confirms that the participant has voluntarily provided their information.
4. In the 'Physician Office Completes' section, ensure that the testing and measurement dates fall within the specified range of 8/1/2013 to 8/1/2014. Fill in the dates of tests performed as required.
5. For biometric screening metrics, accurately enter the corresponding values for height (in inches and feet), blood pressure, weight (in pounds), glucose levels, total cholesterol, triglycerides, LDL cholesterol, and HDL cholesterol. If any result is unavailable for reporting, enter 'NG'.
6. Complete the physician’s information by providing their or their designee’s signature, printed name, date, UPIN/NPI, and phone number. This information is crucial for the form's processing.
7. After you have filled out the form completely, review all entries for accuracy. Once you are satisfied with the information provided, save the changes, download a copy if necessary, print the form, or share it as needed.

Begin filling out your Physician Results Form online today for a seamless submission experience.