WCIF Health Care Provider Biometric Screening Form 2013-2026 free printable template
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Health Care Provider Biometric Screening Form INSTRUCTIONS MEMBER- Completes Sections 1 2 AND 5. PROVIDER-If patient chooses Option B complete all areas in Section 3 and Section 4. SECTION 3 - BODY MEASUREMENTS / BIOMETRIC RESULTS Height ft in Glucose Fasting Blood Pressure lbs Systolic Yes No Diastolic Cholesterol HDL Screening Date TRI LDL Total Note- Lab screening date must be after 11/15/2012 SECTION 4 - PROVIDER INFORMATION Facility Name Provider s Name Phone Number Provider Signature...
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How to fill out WCIF Health Care Provider Biometric Screening Form
01
Obtain the WCIF Health Care Provider Biometric Screening Form from your employer or the WCIF website.
02
Read the instructions carefully before filling out the form.
03
Provide personal information including your name, address, and date of birth in the designated sections.
04
List your health care provider's information, including their name, address, and phone number.
05
Fill out any required health history questions honestly and accurately.
06
Include recent biometric measurements, such as blood pressure, cholesterol levels, and body mass index, as instructed.
07
Sign and date the form to certify that the information provided is complete and accurate.
08
Submit the completed form to the designated health care provider or workplace representative as instructed.
Who needs WCIF Health Care Provider Biometric Screening Form?
01
Employees participating in the WCIF wellness program.
02
Individuals seeking to monitor their health and receive biometric screenings as part of their overall health assessment.
03
Health care providers who need to document biometric data for patient health records.
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What is WCIF Health Care Provider Biometric Screening Form?
The WCIF Health Care Provider Biometric Screening Form is a document used to collect health-related biometric data from individuals for the purposes of health assessments and wellness programs.
Who is required to file WCIF Health Care Provider Biometric Screening Form?
Individuals participating in wellness programs or health assessments provided by the WCIF (Washington Counties Insurance Fund) are typically required to file this form.
How to fill out WCIF Health Care Provider Biometric Screening Form?
To fill out the WCIF Health Care Provider Biometric Screening Form, individuals must provide accurate personal information, health metrics such as blood pressure and cholesterol levels, and may need to have their data recorded by a certified health care provider.
What is the purpose of WCIF Health Care Provider Biometric Screening Form?
The purpose of the WCIF Health Care Provider Biometric Screening Form is to gather essential health information to support health initiatives, improve individual health outcomes, and facilitate risk assessments for better health management.
What information must be reported on WCIF Health Care Provider Biometric Screening Form?
The WCIF Health Care Provider Biometric Screening Form typically requires information such as the individual's name, age, height, weight, blood pressure, cholesterol levels, and any other relevant health metrics as specified by WCIF.
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