Get Health Insurance Program - Rsa-al

Filling out the Health Insurance Program - Rsa-al form online is a straightforward process. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to complete your Health Insurance Program - Rsa-al form online.

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Begin by providing the healthcare provider's name, type, address, and phone number in the designated fields. Ensure that all information is printed clearly.
3. In Section 1, fill out the personal details for the active or retired employee or their spouse, including their name, contract number, and date of birth.
4. Indicate whether the patient has used any tobacco products in the past 12 months by selecting 'Yes' or 'No'.
5. Complete the screening information, including the patient's height, weight, blood pressure, blood glucose levels, and cholesterol levels. Make sure to use the correct units for each measurement.
6. Provide answers to the health-related questions, including those regarding high cholesterol, high blood pressure, diabetes, and medication usage.
7. In the section regarding race/ethnicity, select the appropriate option that best describes the patient.
8. Ensure to sign and date the form at the bottom, ensuring the healthcare provider's signature is present.
9. After reviewing the completed form for accuracy, save your changes, and you can then download, print, or share the form as needed.

Encourage others to complete their Health Insurance Program - Rsa-al form online.