Printable biometric screening form 2020-2025

1. Click ‘Get Form’ to open the printable biometric screening form 2020 in the editor.
2. Begin by filling out Part I, which requires your personal information. Enter your first and last name exactly as it appears on your payroll stub or medical benefits card. Ensure you complete all fields marked with an asterisk (*) as they are mandatory.
3. Provide your date of birth in the format MM/DD/YYYY, select your gender, and include your phone number and email address for communication purposes.
4. In the Member Attestation/Authorization section, read through the statement carefully. Sign and date the form to authorize your Health Care Provider (HCP) to report your results.
5. Part II must be completed by your HCP. Ensure they fill in all required fields including screening date, fasting status, and various health metrics such as cholesterol levels and blood pressure.
6. Once both parts are completed, review the entire form for accuracy and legibility before submitting it via fax or secure email as instructed.

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