Get Auburn University Healthy Tigers Provider Screening Form 2016-2025

Completing the Auburn University Healthy Tigers Provider Screening Form online is a straightforward process. This guide provides a step-by-step approach to ensure that you accurately fill out each section of the form.

Follow the steps to successfully complete your form.

1. Click ‘Get Form’ button to obtain the form and access it in the editing interface.
2. In Section 1, input your personal information. Begin with your name printed clearly, followed by your subscriber banner number, sex (select either Male or Female), age, and date of birth.
3. Continue with the subscriber name as it appears on your AU BCBS insurance card. Provide your AU BCBS contract number and group number. Then, include your daytime or campus phone number and e-mail address.
4. Indicate your race/ethnicity by checking the appropriate option that best describes you from the listed categories.
5. Mark any of the health conditions that apply to you, such as High Cholesterol, High Blood Pressure or Hypertension, and Diabetes. If you take medication for any of these, please mark those as well.
6. In Section 2, ensure your healthcare provider fills out the required data including blood pressure, height, total cholesterol, weight, and blood glucose levels. They should also calculate and record your BMI.
7. Make note of alarm values for any readings that may exceed normal thresholds and communicate these with your provider.
8. Have your healthcare provider sign and date the section confirming the evaluations performed.
9. After completing all sections of the form, save your changes. You can choose to download, print, or share the form as needed.

Ensure your form is completed accurately and submit it online to participate in the Healthy Tigers program.