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The General Health Evaluation & Level of Care Recommendation form is to be completed by a nurse from the Home and Community Based Services (HUBS) provider. The intention of the multipurpose evaluation
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How to fill out the general health evaluation

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To fill out the general health evaluation, follow these steps:
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Start by gathering all necessary information and documents such as medical history, previous test results, and current medications.
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Begin with the personal information section and provide accurate details about your name, age, gender, contact information, and any other requested details.
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Move on to the medical history section and carefully answer all the questions regarding your past and current medical conditions, surgeries, allergies, and family history of diseases.
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Complete the section related to lifestyle and habits, which may include questions about smoking, alcohol consumption, exercise routine, and diet.
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Answer all the questions about your current symptoms, if any, and provide details about the nature, duration, and severity of the symptoms.
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Who needs the general health evaluation?

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The general health evaluation is recommended for anyone interested in assessing their overall health status.
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It can be particularly beneficial for individuals who:
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- Have a family history of diseases and want to understand their risk factors.
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- Experience recurring or persistent health issues and want to identify underlying causes or conditions.
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- Are starting a new job or enrolling in certain educational programs that require a health evaluation.
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- Are planning to undergo surgical procedures or certain medical treatments.
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- Are interested in preventative healthcare and proactively monitoring their health.
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- Wish to establish a baseline of their health status for future comparison and tracking.
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It is always advisable to consult with a healthcare professional to determine if a general health evaluation is necessary in your specific case.

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The general health evaluation is a comprehensive assessment of an individual's overall health and well-being. It may include physical examinations, medical history review, and laboratory tests.
The general health evaluation may be required for individuals seeking certain types of insurance coverage, employment in certain industries, or participation in certain programs.
The general health evaluation can be filled out by providing accurate and complete information about one's medical history, current health status, and any relevant test results.
The purpose of the general health evaluation is to assess an individual's health status, identify any potential health risks or conditions, and make recommendations for preventative care or treatment.
The general health evaluation may require reporting of information such as medical history, current medications, past surgeries or procedures, family medical history, and lifestyle habits.
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