Get Auburn University Healthy Tigers Provider Screening Form 2015-2025

The Auburn University Healthy Tigers Provider Screening Form is an essential document that helps ensure the well-being of employees and their dependents. This guide provides clear, step-by-step instructions for successfully completing the form online, making the process efficient and straightforward.

Follow the steps to complete the form online efficiently.

1. Click ‘Get Form’ button to access the Healthy Tigers Provider Screening Form and open it in your preferred editor.
2. Fill in your personal details in Section 1. Start by entering your name, employee ID or banner number, age, date of birth, and gender. Please ensure that all information is accurate and clearly printed.
3. Provide your subscriber name exactly as it appears on your AU BCBS insurance card along with your AU BCBS contract number. This information is crucial for verifying your insurance coverage.
4. Enter your daytime or campus phone number and your email address. This ensures that you can receive any follow-up communications regarding your health screening.
5. Select one of the options regarding your insurance coverage status by marking the appropriate box, indicating whether you are an AU employee or a dependent.
6. In the section that asks about your race/ethnicity, mark the option that best reflects your background. This information helps in understanding the health trends within the population.
7. Indicate any health conditions by marking all that apply regarding high cholesterol, high blood pressure, and diabetes. This section is essential for assessing your health screening needs.
8. If you take medication for any of the listed conditions, mark the appropriate boxes, and optionally provide a list of all medications on the back of the form.
9. Indicate your tobacco usage by marking whether you are a current smoker, former smoker, or have never smoked. This information aids in assessing health risks.
10. Complete Section 2 with your healthcare provider. This section requires your provider to fill in necessary health data including blood pressure, height, cholesterol levels, weight, and blood glucose levels.
11. Ensure that your healthcare provider includes their name, signature, and the date tests were performed. This verification is essential for the legitimacy of your screening results.
12. Review the entire form for accuracy. Once complete, save any changes, download, print, or share the form as needed.

Complete your Auburn University Healthy Tigers Provider Screening Form online today for a healthier tomorrow!