Get 2017 Iu Health Provider Option Form Important

Filling out the 2017 IU Health Provider Option Form IMPORTANT online can seem daunting, but it is a straightforward process when you follow the steps outlined in this guide. This document is essential for ensuring that you receive your health incentives, and it is important to complete it thoroughly.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the document and open it in your online editor.
2. Begin by filling out the participant information section. This includes entering your first name, last name, last four digits of your Social Security Number, primary phone number, date of birth in the mm/dd/yyyy format, and email address (the email is required for confirmation).
3. Indicate your gender by selecting 'Male' or 'Female' and answer the questions regarding pregnancy and tobacco use, along with confirming if you have fasted for at least 8 hours.
4. Provide the physician's name and phone number along with their signature to confirm the necessary biometric information has been collected.
5. Complete the biometric information section. This includes entering details such as height, weight, blood pressure readings, cholesterol levels, and glucose readings. Make sure to enter all fields accurately.
6. Read and understand the consent information provided in the form. Your consent is essential for using the health screening information and for data tracking purposes.
7. Finally, ensure all required sections are filled out and both you and your provider have signed the form. Review all the information for accuracy.
8. After completing the form, retain a copy for your records. You may then fax it securely to 402.881.8422 or mail it to TotalWellness, Attn: Data Team, at the specified address. Ensure that this is done by November 30, 2017.
9. Keep proof of submission, either as a fax confirmation or USPS certificate of mailing. Also, expect a confirmation email from TotalWellness within 5 business days; if it is not received, resubmit the form.

Take the first step towards your health incentives by completing the 2017 IU Health Provider Option Form online today.