Get Health Risk Screening Form - Coordinated Care Health

Filling out the Health Risk Screening Form is an essential step in ensuring your health information is accurate and up-to-date. This guide will help you navigate the process of completing the form online, ensuring clarity and ease throughout the experience.

Follow the steps to accurately complete the form online:

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the member's last name in the designated field.
3. Next, provide the member ID in the required field to ensure proper identification.
4. Input the member's date of birth in the format mmddyyyy for accurate record-keeping.
5. Complete the name of the person answering the questions, ensuring their role is clear.
6. Indicate the relationship to the member by selecting one of the options provided, such as partner or guardian.
7. Choose how you are submitting this form from the given options, like online, mail, or fax.
8. If a return call is necessary, provide the best time and phone number to reach you.
9. Select the member's gender identity from the available options.
10. Enter the member's height in feet and inches, followed by their weight in pounds.
11. If the primary language is other than English, specify it in the provided space.
12. Indicate your primary care provider's name and contact number if applicable.
13. Answer the questions regarding your health, including any hospital admissions and medications.
14. If applicable, address questions regarding pregnancy and any relevant healthcare needs.
15. Check all current medical conditions that apply and provide information regarding any special needs.
16. Review the completed form for accuracy, ensuring all required fields are filled out correctly.
17. Once all information is confirmed, save your changes, and choose to download, print, or share the form as needed.

Start completing your Health Risk Screening Form online today to ensure your health needs are met.