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20152016WellnessIncentiveProgram HealthcareProviderVerificationForm Instructions:ThequalifyingperiodforsubmissionisJuly1,2015toJune30,2016. Completeallfieldsofthisformand submitacopytotheWellnessCouncilofArizona.
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Gather all necessary documents and information, such as your identification, insurance information, and medical history.
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Your phi personal health consists of your personal health information such as medical history, current medications, lab results, and treatment plans.
You are required to file your phi personal health information. However, healthcare providers and insurance companies may also have access to this information.
You can fill out your phi personal health by providing accurate and up-to-date information about your health status, medical conditions, and treatment you may be receiving.
The purpose of your phi personal health is to ensure that healthcare providers have access to your medical information in order to provide you with appropriate and effective care.
Your phi personal health should include information such as your medical history, current medications, allergies, immunizations, lab results, and treatment plans.
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