Get Optout Form For Bmi Growth Module - Mcir - Mcir

Filling out the OptOut Form for the BMI Growth Module is essential for individuals who wish to decline the reporting of their or their child's height and weight data to the Michigan Care Improvement Registry. This guide provides clear instructions to assist you in successfully completing the form online.

Follow the steps to complete the form online.

1. Click the ‘Get Form’ button to obtain the OptOut Form. This will open the document in an accessible format for editing.
2. Begin by filling in the Child or Individual Information section. You will need to enter the last name, first name, and middle name of the child or individual. Additionally, include the MCIR ID, which uniquely identifies the individual, and the date of birth in the specified format (MM/DD/YYYY).
3. Next, proceed to the Parent/Guardian or Individual Contact Information section. Here, you must provide the last name, first name, and middle name of the parent or guardian. Indicate your relationship to the child and provide a contact phone number, ensuring it's accurate for potential follow-up.
4. In the statement section, indicate your preference by checking the appropriate box. If you wish to object to the reporting, select the first option. If you are rescinding a previous objection, check the second option.
5. Next, sign the form to validate your request and include the date of signature. This is necessary for processing your form.
6. Finally, review all filled sections for accuracy. Once confirmed, you can save the changes made to the form. You may also choose to download, print, or share the completed form as needed.

Get started by filling out your OptOut Form online today.