Get Physician Results Report Form - Healthyroads

The Physician Results Report Form is an essential document for participants in the Healthyroads wellness program. This guide provides you with clear instructions on how to fill out the form online, ensuring that your physician can report your laboratory and biometric results accurately.

Follow the steps to complete your Physician Results Report Form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the 'Associate Information' section. Provide your full name, vendor ID, screening date, date of birth, and phone number. Ensure that all entries are accurate.
3. Next, complete the ‘MY BIOMETRIC SCREENING RESULTS’ section. Enter your height in feet and inches, weight in pounds, and blood pressure (systolic and diastolic values). Include laboratory values for glucose, total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides.
4. After entering your biometric data, your ADP Health Care Provider, Primary Care Physician, or Nurse Practitioner must sign the form. They should also fill in their name, phone number, and UPIN/NPI.
5. Once the form is fully completed and signed, it should be faxed to Quest Diagnostics or returned to you for faxing to 855-794-1391. Make sure to confirm the fax transmission for proper processing.
6. Review the completed form for accuracy before finalizing. Save your changes, then download, print, or share the form as needed.

Complete your Physician Results Report Form online to participate in your employer's wellness program today.