Medicare health risk assessment form 2021 pdf-2026

1. Click ‘Get Form’ to open the Medicare Health Risk Assessment Form 2021 PDF in the editor.
2. Begin by entering your personal information at the top of the form, including your name, date of birth, and today's date.
3. In Section 1, list any updates to your past medical history. Be specific about serious illnesses, injuries, or surgeries.
4. For Section 2, provide your latest blood pressure, cholesterol, and glucose readings. Circle the appropriate answers based on your last tests.
5. Section 3 requires you to list other physicians you see and the problems they address. Fill in each field accurately.
6. In Section 4, indicate where you obtain medications and medical supplies. Specify suppliers and related problems.
7. Complete Sections 5 through 12 by circling relevant conditions and answering questions regarding tobacco use, alcohol consumption, general health, daily activities, physical activity, nutrition, and emotional support.

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