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Patient Health History Questionnaire H ea l i n g Try an n s for m a ti on s Date: Last Name: First Name: Birthdate: Address:Phone: HomeKit:State:Zip:Overage: Family Physician:Referred by:In Emergency,
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What is h ea l i?
H e a l i stands for Health Coverage Tax Form.
Who is required to file h ea l i?
Individuals who have had health coverage through the Marketplace are required to file h e a l i.
How to fill out h ea l i?
You can fill out h e a l i by providing information about your health coverage and any exemptions you may qualify for.
What is the purpose of h ea l i?
The purpose of h e a l i is to report information about your health coverage to the IRS.
What information must be reported on h ea l i?
You must report information about your health coverage, including the months you were covered and any exemptions you may qualify for.
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