Get Prevention Activity Form - Power Of Vitality

Filling out the Prevention Activity Form - Power Of Vitality online is a straightforward process that enables you to document and submit your prevention activities efficiently. This guide will walk you through each section of the form, ensuring you complete it accurately to earn Vitality Points.

Follow the steps to fill out the Prevention Activity Form online:

1. Press the ‘Get Form’ button to obtain the form and open it for editing.
2. In Section A: Member Information, enter your first name, last name, Vitality ID, and date of birth. If you are submitting for a dependent, provide their first name, last name, relationship to you, and date of birth.
3. In Section B: Prevention Activity, specify the activity by selecting from the provided options. Input the date of the activity and the provider’s name.
4. Indicate which documents are included by checking the corresponding boxes. Ensure that you attach a copy of the Explanation of Benefits, physician claim form with relevant CPT codes, medical record, or certificate documenting the date and service.
5. Review the completed form for accuracy. Once you are satisfied with your input, you can save the changes, download a copy for your records, print the form, or share it as required.

Complete the Prevention Activity Form online today to ensure your activities are properly documented and eligible for Vitality Points.