Alabama peehipscrhlthcr screening form make 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section 1, where you will enter your Contract Number and Social Security Number (SSN) of the person being screened. Ensure you print clearly using a black ink pen.
3. Fill in the Screening Date and select the appropriate gender option by darkening the box completely. Provide your Birth Date and Daytime Phone Number.
4. Indicate if the screening was not performed due to pregnancy or disability, and select your race/ethnicity from the provided options.
5. Answer questions regarding any medical conditions such as High Cholesterol, High Blood Pressure, or Diabetes, and indicate if you take medication for these conditions.
6. In Section 2, leave this section for your healthcare provider to complete. They will fill in vital statistics like Blood Pressure, Blood Glucose, Total Cholesterol, Height, Weight, and more.
7. Once completed, review all entries for accuracy before submitting. Use our platform’s features to save or share your document as needed.

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