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  • Mi Dch-1315 2018

Get Mi Dch-1315 2018-2025

Health Risk Assessment INSTRUCTIONS The Healthy Michigan Plan is very interested in helping you get healthy and stay healthy. You can also learn more at this website www. healthymichiganplan.org. Instructions for completing this Health Risk Assessment for Healthy Michigan Plan Answer the questions in sections 1-3 as best you can. You are not required to answer all of the questions. I have provided a copy of this Health Risk Assessment to the member listed above. Provider Last Name Provider First Name National Provider Identifier NPI Provider Telephone Number Signature Date Submit form by fax or via CHAMPS Fax to 517-763-0200 CHAMPS The Health Risk Assessment form can be submitted and viewed in the CHAMPS system via the Health Risk Assessment Questionnaire Web Page. The Michigan Department of Health and Human Services does not discriminate against any individual or group because of race religion age national origin color height weight marital status genetic information sex sexual orient....

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Related content

Health Risk Assessment - State of Michigan
DCH-1315 (10/18). Page 1 of 5. Health Risk Assessment. INSTRUCTIONS. The Healthy Michigan...
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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232