Get Biometric Screening Form

Filling out the Biometric Screening Form is essential for participating in the wellness program. This guide will provide you with clear, step-by-step instructions to successfully complete the form online, ensuring that you accurately provide all required information.

Follow the steps to complete the Biometric Screening Form online accurately.

1. Click ‘Get Form’ button to access the Biometric Screening Form and open it for editing.
2. In Section 1, enter your employee information, including your first name, last name, date of birth, gender, member medical ID number, daytime telephone number, and email address.
3. Proceed to Section 2. Choose either Option A or Option B. If you select Option A, ensure you have entered your lab values into Section 3 of the form and are prepared to fax your lab slip along with it. If you select Option B, confirm that your provider will complete Sections 3 and 4.
4. In Section 3, whether you or your provider are filling it out, enter your biometric results, including height, weight, glucose levels, blood pressure readings, and cholesterol levels as specified. Make sure all information is accurately recorded.
5. Complete Section 4 by providing information about your healthcare provider, including their name, facility name, and phone number. If Option B was selected, ensure the provider has signed the form.
6. In Section 5, as the employee, sign and date the form to confirm your understanding that your data will be shared with your health plan while maintaining confidentiality.
7. Finally, review Section 6 to confirm that you have completed all sections and actions. Check off each item to ensure nothing is overlooked.
8. Once all steps are completed, fax the form to the number provided. Remember to keep a copy of the form for your records.

Complete your Biometric Screening Form online today to ensure your participation in the wellness program!