Get Generic Biometric Screening Form

The Generic Biometric Screening Form is an essential document used to gather important health information for individuals participating in wellness programs. Completing this form online streamlines the process, ensuring that your health data is accurately recorded and submitted with ease.

Follow the steps to complete the Generic Biometric Screening Form online:

1. Press the ‘Get Form’ button to access the Generic Biometric Screening Form and open it in your preferred editor.
2. In Section 1, complete the patient information. Fill out the patient's date of birth in MM/DD/YYYY format, include the employee ID number, and select the gender by marking the appropriate box.
3. Enter the patient's first and last name along with their unit or apartment number, street address, city, state, and zip code.
4. Provide the patient's phone number formatted with dashes. Finally, enter the date, and ensure the patient signs the designated area.
5. In Section 2, which is for the health care provider's use, the provider needs to input biometric measurements. Fill in the height, weight, waist circumference, blood pressure, pulse, and BMI.
6. For laboratory results, include fasting glucose levels, triglycerides, total cholesterol, HDL, and LDL values. It is necessary to certify that the listed biometric values are accurate by providing the date of service or test.
7. Enter the facility name, health care provider's name, and phone number. The provider must sign the form and provide the date.
8. After completing the form, you can save the changes, download, print, or share the completed Generic Biometric Screening Form.

Complete your Generic Biometric Screening Form online today to ensure efficient submission of your health information.