Get Peehip Wellness Screening Form 2019

Filling out the Peehip Wellness Screening Form 2019 is an essential step for active and retired employees or their spouses to participate in the wellness program. This guide provides a clear and supportive approach to completing the form online, ensuring that you provide all necessary information accurately.

Follow the steps to successfully complete your wellness screening form online.

1. Press the ‘Get Form’ button to access the wellness screening form and open it in your preferred online document editor.
2. Begin by completing Section 1, where you will provide your contract number and Social Security Number (SSN) of the person being screened. Ensure you write clearly, using black ink if doing it on paper. Include the date of the screening and mark the appropriate box to indicate the gender of the contract holder or spouse.
3. Next, enter your birth date and provide a daytime phone number for contact. List your last and first names as requested.
4. If the screening was not performed, specify the reason by selecting from the options provided, such as pregnancy or disability.
5. Indicate your race/ethnicity by selecting one of the provided categories. This information is important for health monitoring and research purposes.
6. Answer the health questions related to high cholesterol, high blood pressure, and diabetes. Indicate whether you have these conditions or have been advised of having them.
7. Indicate if you take any medication for the health conditions mentioned in the previous step.
8. Proceed to Section 2, which must be completed by your healthcare provider. They will fill in blood pressure, blood glucose, and cholesterol levels along with your height, weight, waist measurements, and waist-to-height ratio.
9. Your provider will also indicate if you have used any tobacco products in the last 12 months, so ensure you provide them with accurate information.
10. Finally, after all sections are filled out, review the form for accuracy. You can then save your changes, download, print, or share the completed form as required.

Complete your wellness screening form online today to ensure prompt processing and participation in the PEEHIP wellness program.