Ohio State University Health Screening Form 2023
This form is used for participants of The Ohio State University health and well-being program to complete biometric health screenings. Physicians must fill out and submit this form with the necessary data. It is crucial for earning incentives and maintaining the health plan requirements.
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How do I fill this out?
To fill out this form, start by providing your personal information in Section 1. Next, have your physician complete Section 2 with the required health measurements. Finally, make sure the form is submitted via fax or secure email for processing.
How to fill out the Ohio State University Health Screening Form 2023?
1
Print the form and fill out Section 1 with your details.
2
Schedule an appointment with your physician to complete Section 2.
3
Ensure all required fields are filled accurately.
4
Sign the form where indicated and date it.
5
Submit the completed form via fax or secure email.
Who needs the Ohio State University Health Screening Form 2023?
1
Health program participants need it to complete their biometric screening.
2
Physicians require it to record patient data for the health plan.
3
HR personnel might need it for employee wellness verification.
4
Insurance administrators need it for benefit processing.
5
Wellness coordinators use it to assess participant health metrics.
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What are the instructions for submitting this form?
To submit this form, fax it to The Ohio State University Health Plan at (614) 688-9670 or send it via secure email to yp4h.clinicalservices@osumc.edu. Ensure all fields are completed and the form is signed before submission. Keep a copy for your records and adhere to the deadlines for rewards and benefits.
What are the important dates for this form in 2024 and 2025?
For 2024, forms accepted until 5:00 PM on December 20, 2024 for YP4H points and until 11:59 PM on December 31, 2024 for OSUHP premium credit. For 2025, similar deadlines are expected, ensure to check for updates.
What is the purpose of this form?
This form serves to facilitate the completion of biometric health screenings required by The Ohio State University’s health program. It collects essential health data from participants to enhance their well-being and ensure they meet the necessary health plan requirements. Ultimately, it aims to support health education and management through the collection and analysis of health metrics.
Tell me about this form and its components and fields line-by-line.
- 1. Last Name: The participant's family name.
- 2. Birth Date: The participant's date of birth.
- 3. First Name: The participant's first name.
- 4. Phone: Preferred method of contact phone number.
- 5. Email: Preferred email for questions.
- 6. Participant/Patient Signature: Signature of the participant confirming the information.
What happens if I fail to submit this form?
Failure to submit this form may result in the inability to access certain health plan incentives and services. Participants may forfeit potential rewards associated with their health screenings. Additionally, it may affect their eligibility for healthcare benefits.
- Missed Incentives: Participants may miss out on health discounts and benefits.
- Inaccurate Health Records: Failure to submit can lead to gaps in health records.
- Delayed Health Support: Delays in accessing necessary health programs could occur.
How do I know when to use this form?
- 1. Biometric Screening: Required for participants to complete their annual health screening.
- 2. Health Plan Compliance: Necessary for compliance with the health plan's requirements.
- 3. Incentive Eligibility: Ensures access to health program incentives.
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