Get Physician Biometric Screening Results Fax Form

This guide provides clear instructions on how to accurately complete the Physician Biometric Screening Results Fax Form online. By following the outlined steps, users can ensure their form submission is complete and meets all requirements for participation.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In the participant information section, fill in your personal details including your name, employee ID (PERNR), relationship to employee, birth date, and gender. Ensure that all fields are completed as this information is required for processing.
3. Sign and date the consent section, acknowledging your participation in the Biometric Health Screening, as well as the sharing of your health information with relevant parties.
4. Next, the provider will need to enter the participant's biometric values. This includes measurements for height, weight, blood pressure, cholesterol, and glucose levels. The provider should print the results clearly.
5. The provider must also provide their name, title, and signature, along with the provider's phone number and the date when the biometric measurements were taken.
6. Once all sections are completed, review the form for accuracy. After verifying that all information is correct, you can save the changes, and choose to download, print, or share the form as needed.

Ensure your health benefits are secured by completing your Physician Biometric Screening Results Fax Form online today.