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Health Risk Assessment
INSTRUCTIONS
Health Risk
Assessment
INSTRUCTIONS
The Healthy Michigan Plan is very interested in helping you get healthy and stay healthy. We want to ask you a few
questions
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02
Start by gathering all the necessary personal information such as name, date of birth, address, and contact details.
03
Provide your medical history, including previous illnesses, surgeries, and any known allergies.
04
Mention any ongoing medications you are taking along with the dosage and frequency.
05
Fill in details about your primary care physician or any other specialists you are currently seeing.
06
Provide information about your health insurance coverage, including the policy number and contact details.
07
If applicable, provide any advance directives or living wills that outline your medical preferences in case of incapacitation.
08
Sign and date the form to validate your information.
09
Review the completed form for accuracy and make corrections if necessary.
10
Keep a copy of the filled-out form for your records.
11
Submit the completed form to your healthcare provider or keep it handy for future reference.
Who needs your doctor and your?
01
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Having an up-to-date and accurate medical information sheet can significantly help healthcare professionals in providing appropriate and timely care.
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What is your doctor and your?
Your doctor and your refers to the medical information and personal details belonging to you and your healthcare provider.
Who is required to file your doctor and your?
Your doctor and your should be filed by the healthcare provider who is treating you.
How to fill out your doctor and your?
Your doctor and your can be filled out by providing accurate and up-to-date medical information, personal details, and any other required information.
What is the purpose of your doctor and your?
The purpose of your doctor and your is to maintain accurate medical records for the patient and ensure proper treatment and care.
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Information such as medical history, current medications, allergies, and any ongoing treatments must be reported on your doctor and your.
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