Edit, Download, and Sign the Humana Biometric Screening Form Instructions
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How do I fill this out?
To fill out the Go365 biometric screening form, gather all required member information before your appointment. Ensure that your doctor or health professional completes their section accurately. Finally, submit the form following the outlined submission methods.
How to fill out the Humana Biometric Screening Form Instructions?
1
Gather your personal and health information.
2
Make an appointment with a healthcare provider.
3
Complete your section of the form before the appointment.
4
Ensure the healthcare provider completes their section.
5
Submit the form by the prescribed methods before the deadline.
Who needs the Humana Biometric Screening Form Instructions?
1
Medicare beneficiaries who need to document their health metrics.
2
Individuals participating in the Go365 program for wellness rewards.
3
Patients scheduled for an Annual Wellness Visit.
4
Those seeking to improve their health by tracking biometric data.
5
Healthcare professionals who need to submit patient screening results.
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1
Open the PDF in PrintFriendly.
2
Use the editing tools to make necessary changes.
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Save your changes to ensure accuracy.
5
Download or share the edited PDF as needed.
What are the instructions for submitting this form?
To submit the Go365 Biometric Screening Form, you can send it via fax to 1-877-250-7814. For online submission, log in at Go365.com and use the Quick Links section to find Forms. Alternatively, you can mail the completed form to Go365, P.O. Box 14613, Lexington, KY 40512-4613. Ensure your submission is made before the deadlines to avoid any issues.
What are the important dates for this form in 2024 and 2025?
For 2024, ensure that you submit your completed form by December 15. For 2025, the same deadlines will apply for processing and benefits redemption. Note that all Bucks must be spent by December 31 of each year to avoid expiration.
What is the purpose of this form?
The Go365 Biometric Screening Form serves to record essential health metrics that contribute to your wellness journey. It ensures that members of the Go365 program can track their health data efficiently and accurately. This information is vital for both patients and healthcare providers in managing health and wellness goals.
Tell me about this form and its components and fields line-by-line.
- 1. Member ID number: A unique identifier for the patient.
- 2. First name: The first name of the individual.
- 3. Last name: The last name of the individual.
- 4. Date of birth: The individual's date of birth in MM/DD/YYYY format.
- 5. Phone number: Contact number for the member.
- 6. Height: Height measurement in inches.
- 7. Weight: Weight measurement in pounds.
- 8. Blood pressure: Systolic and diastolic blood pressure readings.
- 9. Cholesterol levels: Documentation for total, LDL, HDL cholesterol.
- 10. Blood glucose: Measurement of blood sugar levels.
- 11. Waist circumference: Measurement of waist in inches.
- 12. Consent: Member's signature and consent to share information.
What happens if I fail to submit this form?
Failure to submit the Go365 Biometric Screening Form can result in the forfeiture of wellness rewards. Additionally, inaccurate submissions may lead to denied benefits or audits.
- Expiration of Bucks: Any unused Bucks will expire if not redeemed by year-end.
- Inaccurate Health Data: Inaccurate submissions may prevent tracking of your health improvements.
- Delayed Processing: Late submissions may not be processed in time for annual benefits.
How do I know when to use this form?
- 1. Annual Wellness Visits: Use this form when visiting your doctor for preventive check-ups.
- 2. Routine Health Screenings: Document results during standard health screenings.
- 3. Go365 Program Submissions: Submit this form to earn wellness rewards from Go365.
Frequently Asked Questions
What is the Go365 Biometric Screening Form?
It is a form used by Humana to document biometric health screening results.
How do I fill out this form?
You need to provide your personal information and ensure your healthcare provider completes their section.
What happens if I miss the submission deadline?
If the form isn't submitted on time, you may not receive wellness rewards.
Can I edit the form before submitting?
Yes, you can use PrintFriendly to edit the PDF as needed.
How do I share the form?
You can share the form via email or direct links through PrintFriendly.
Is there a cost to use PrintFriendly?
Using PrintFriendly for editing and downloading forms is free!
How can I sign the form electronically?
PrintFriendly allows you to add your signature directly to the PDF.
What type of biometric data do I need?
You will need height, weight, blood pressure, cholesterol, and glucose levels.
How do I submit the completed form?
Completed forms can be submitted via fax, mail, or online through Go365.
Who can I contact for assistance?
You can contact the number listed on your ID card for support.
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