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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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How to fill out the MI DCH-1315 online

This guide provides essential instructions for completing the MI DCH-1315 form online. By following the outlined steps, users can efficiently provide their health information, which will be used to enhance their care under the Healthy Michigan Plan.

Follow the steps to complete the MI DCH-1315 form.

  1. Click the ‘Get Form’ button to retrieve the MI DCH-1315 and open the document in your preferred online editor.
  2. Enter your personal information in the designated fields at the beginning of the form. This includes your first name, middle name, last name, suffix (if applicable), date of birth, mailing address, phone number, and MI Health Card number. Ensure that this information is accurate and up to date.
  3. Proceed to Section 1, where you will respond to initial assessment questions. For each question, select the answer that best represents your current health status or situation. Remember that not all questions require a response, and providing accurate information helps in meeting your healthcare needs.
  4. In Section 2, you will fill out details regarding your annual check-up appointment. Enter the date of your appointment in the provided field and specify any topics you wish to discuss with your doctor.
  5. Section 3 requires you to reflect on your readiness to make changes to improve your health. Answer the questions on a scale of 0 through 5, considering the support you feel you would receive from family, friends, and your healthcare provider.
  6. Section 4 is to be completed by your primary care provider. Ensure that they fill out the necessary parts during your appointment. This includes assessing your health behavior goals and providing their attestation.
  7. After your appointment, make sure to save a copy of the completed form, particularly the section signed by your primary care provider. This document serves as your record of participation in the Health Risk Assessment.
  8. Finally, once you have filled out all applicable sections, save your changes, download a copy, print the form, or share it as necessary. Follow any further instructions provided for submitting the completed document.

Complete your MI DCH-1315 form online today to take an active role in your health care.

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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