Get Medical Results Form

Filling out the Medical Results Form online is a straightforward process that supports patients in monitoring their health as part of an incentive program. This guide will provide you with clear, step-by-step instructions to ensure you complete the form accurately.

Follow the steps to successfully complete the Medical Results Form online.

1. Press the ‘Get Form’ button to access the Medical Results Form and open it in your preferred editor.
2. In Section 1, enter your participant information. This includes your name (last, first, middle initial), date of birth, member ID number if applicable, home address, gender, and phone number. Ensure all information is accurate.
3. Read the declaration regarding the accuracy of the supplied information. Provide your consent by indicating your agreement.
4. Next, move to Section 2 to have your physician complete the results section. This includes details on current tobacco use, diagnosed conditions, and key health metrics such as height, weight, LDL, blood pressure, and HbA1c.
5. Make sure your physician signs the form, entering their name, NPI number, and phone information in the designated fields within Section 3.
6. Review all sections for completeness and accuracy before submitting the form.
7. Once verified, you can choose to save your changes, download, print, or share the completed form as required.

Complete your Medical Results Form online today to stay on top of your health management!