Get Take Charge Live Well

Filling out the Take Charge Live Well online can be a straightforward process if you follow these guided steps. This guide provides an easy-to-understand approach to successfully complete the form.

Follow the steps to complete the form effectively.

1. Click the ‘Get Form’ button to access the document and open it for editing.
2. In Section 1, provide your last name and first name in the designated fields. Ensure that the names are written clearly as required.
3. Enter your birth date in the format MM/DD/YYYY. This information is crucial for identification purposes.
4. Indicate your preferred method of contact for any questions, including at least one option from the phone or email sections.
5. Carefully read the disclosure statement regarding the use and confidentiality of your biometric data, then provide your signature and the date in the required fields.
6. In Section 2, which is to be completed by your physician or provider, ensure they fill in the exam date, height, weight, BMI, gender, and blood pressure accurately.
7. Your provider should also record your pulse rate, pregnancy status, and relevant blood panel information, including cholesterol and blood glucose levels as necessary.
8. Your physician or provider must sign the form, print their name, and provide their office phone number and address.
9. Ensure that the completed form is faxed to the designated OSU Health Plan number by the deadline specified.
10. Once all sections are complete, you can save your changes, download the document for your records, print it, or share it as needed.

Complete your documents online today to ensure timely submission and maintain your wellness participation.