Get Hsrp Application Form

The Hsrp Application Form is crucial for documenting cases of ischemic vascular disease with accuracy and detail. This guide will help you navigate the online filling process, ensuring you complete all necessary fields to submit your application successfully.

Follow the steps to fill out the Hsrp Application Form online efficiently.

1. Press the ‘Get Form’ button to access the application form and open it in your editor.
2. Begin by confirming that the subject is at least 18 years old by marking the appropriate field.
3. Indicate if the individual has been diagnosed with ischemic vascular disease as specified by the ICD-9 codes listed in Table 1.
4. Document that the patient has been under the care of the applying physician or physician group for at least 12 months.
5. Fill in the abstraction period information, including the date of the most recent visit and the last date to retrieve data.
6. Complete the gender section by selecting either male or female and entering the date of birth in the required format.
7. Record the most recent blood pressure readings, including systolic and diastolic values, along with the corresponding dates.
8. Enter the lipid profile information, noting the dates and total serum cholesterol, triglyceride, HDL, and LDL levels.
9. Specify whether aspirin use is documented and whether the patient has any contraindications.
10. Provide the patient's smoking status and any advice given regarding smoking cessation, including the relevant dates.
11. Once you have filled in all required fields, save your changes. You can then download, print, or share the completed form as necessary.

Complete your Hsrp Application Form online to ensure timely processing!