1087-1905 14084702 Amazon Provider Incentive Form - Child 1087-1905 14084702 Amazon Provider Incenti-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the member's information, including their name, date of birth, and contact details. Ensure that the email address is accurate as it is required for rewards eligibility.
3. Next, fill out the provider information section with your name, phone number, clinic location, and NPI. This ensures proper identification and communication.
4. Complete the vital signs section by entering the member's blood pressure, height, weight, BMI percentile, and BMI value if applicable.
5. For well-child checkups and immunizations, carefully document each visit date and check off all services provided during those visits. This is crucial for reward eligibility.
6. Once all sections are filled out accurately, review the form for completeness before submitting it via fax or email as instructed.

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