Get Pbc Metallic Wellness Program Provider Biometric Screening Form

Completing the PBC Metallic Wellness Program Provider Biometric Screening Form online is a straightforward process that ensures you provide essential health information accurately. This guide will walk you through each section of the form to help you fill it out efficiently.

Follow the steps to accurately complete your form.

1. Press the ‘Get Form’ button to access the form and open it in your digital document editor.
2. In Section 1, enter your personal information including your first name, middle initial, last name, date of birth, gender, member medical ID number, suffix (if applicable), daytime telephone number, and email address.
3. Proceed to Section 2, where you must select either Option A or Option B depending on whether you will enter your lab values or have your provider do so.
4. If you select Option A, fill in the lab values in Section 3 and prepare to fax your lab slip along with the completed form. If you select Option B, ensure your provider will fill in the necessary values.
5. In Section 3, enter your body measurements and biometric results, including height, weight, glucose levels, blood pressure readings, and cholesterol levels. Make sure all values are accurate.
6. Section 4 requires you to enter the provider’s information who collected your biometric values, including the facility name and provider's name and phone number.
7. If applicable, check the box for any exceptions regarding medical conditions that may prevent you from completing the screening. Have your provider sign and date this section.
8. In Section 5, sign and date the form, confirming your understanding that your data will be shared as specified.
9. Finally, in Section 6, confirm that all sections have been completed by checking each item. Make sure to keep a copy of the completed form for your records and prepare to fax the form to the specified number.

Start filling out your PBC Metallic Wellness Program Provider Biometric Screening Form online today!