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  2. MLN6775421 – Medicare Wellness Visits - Centers for Medicare ...

    www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/...

    The annual wellness visit (AWV) includes a health risk assessment (HRA). View the HRA minimum elements summary below. A Framework for Patient-Centered Health Risk Assessments has more information, including a sample HRA.

  3. Health Risk Assessment Form - Blue Shield of California

    www.blueshieldca.com/bin/cms/bsca/services/portal/sites/StreamDocumentServlet...

    Reviewed and documented list of current medications, dosage, and last refill date? Yes (Must Attach Meds List) Drug Allergies or Sensitivities?

  4. A quick survey about your health. Mark your answers by completely...

    www.cigna.com/.../medicare/plans-services/2021/health-risk-assessment-form.pdf

    If you have any questions, please call one of our Health Risk Assessment Representatives at 1-800-331-6769 — they’ll be glad to help. TTY users may call 711.

  5. MEDICARE WELLNESS VISIT ASSESSMENT *U3436* - UW Medicine

    www.uwmedicine.org/sites/stevie/files/2019-12/UH3436 Medicare Wellness Visit...

    Health Risk Assessment Questionnaire This questionnaire is required for all First and Subsequent Annual Wellness Visits (AWV) and is used for Welcome to Medicare Visits (also called Medicare Initial Preventive Physical Exam or IPPE).

  6. Health Risk Assessment Questionnaire - Carepatron

    www.carepatron.com/templates/health-risk-assessment-questionnaire

    Use this free Health Risk Assessment Questionnaire (HRA) PDF to identify potential health risks and gain insight into your health profile. Learn how to use, score, and interpret the questionnaire.

  7. Health Risk Assessment (HRA) Form - memorialhermann

    healthplan.memorialhermann.org/.../2022/26_health-risk-assessment-form.ashx

    Do you have one person you think of as your personal doctor or health care provider? 3. Have you completed an advanced directive, medical/financial power of attorney? 4. During the past 12 months, have you had either the flu vaccine that was sprayed in your nose or a flu shot injected into your arm? 5. Have you received the Covid-19 vaccine? 6.

  8. Sample Health Risk Assessment - HQIN

    hqin.org/wp-content/uploads/2022/02/Sample-Health-Risk-Assessment-508.pdf

    Sample Health Risk Assessment (HRA) Overview. Source: A Framework for Patient-Centered Health Risk Assessments - Providing Health Promotion and Disease Prevention . Services to Medicare Beneficiaries (cdc.gov) The HRA questions outlined below are provided as examples. They represent one HRA model. Use

  9. Medicare Health Risk Assessment - Stanford Health Care

    stanfordhealthcare.org/.../smp/docs/standard/medicare-health-risk-assessment.pdf

    Medicine Partners, Stanford Health Care, Stanford Health Care Tri-Valley, or Stanford University. To ensure optimal care coordination, please list below all providers you see on a regular basis.

  10. Health Risk Assessment Questionnaire - UT Health San Antonio

    www.uthscsa.edu/sites/default/files/HRA Template.pdf

    Health Risk Assessment Questionnaire HRA Template 1 Name: _____ Date of Birth: _____ In general, would you say your health is? Excellent Good Fair Poor In general, how satisfied are you with your life? Very satisfied Satisfied

  11. Medicare Health Risk Assessment (HRA) - First Physicians Group

    firstphysiciansgroup.com/wp-content/uploads/2021/Health-History-Questionnaires/...

    Page 1 Rev. 05/2021 Medicare Health Risk Assessment (HRA) For Annual Wellness Visits Patient Name _____ Today’s Date _____ Race /Ethnicity_____ Sex _____ Date of ...