DOC

Health Department Voucher for Humana Vitality Members

By Donald Jones,2014-10-11 15:32
17 views 0
Health Department Voucher for Humana Vitality MembersHeal

    Health Department Voucher for HumanaVitality Members

Height Blood Pressure

    Weight Glucose Screening *

    Waist Circumference Cholesterol Screening *

    Individual Patient Report (member brochure)

    * For the Cholesterol and Glucose Screenings, fasting 9-12 hours prior to your screening is encouraged. To the extent your health permits, no food should be consumed during this time but we

    strongly encourage you to drink plenty of water.

    Visit LivingWell.ky.gov or call 1.877.597.7474 to find the Local Health Department closest to you.

MANDATORY DOCUMENTS TO BRING:

    1. When visiting the Health Department, please bring this Health Department Voucher along

    with Photo Identification (example Driver’s License), and Humana ID Card.

    2. You will register as a patient. When prompted as to the reason for your visit, specify

    “biometric Screening.” When you are seen by the healthcare provider present your voucher

    and state that you are with Humana Vitality. You will NOT be required to pay for the noted

    services. Humana Vitality has agreed to be billed for the noted services provided to you.

    3. Please present this Voucher to the Health Department Provider at the beginning of

    your visit so that we can ensure the appropriate services are performed. Health Department

    Provider will collect this Voucher from you.

    The Kentucky Local Health Departments are professional, preventive healthcare clinics located in each county of the Commonwealth. The mission of Public Health is to improve the health and safety of people in Kentucky through Prevention, Promotion and Protection using

    education, service and innovative partnerships.

    Once Screening is complete, results could take up to 45 days to appear in your Humana Vitality account.

    For Kentucky Health Department Provider

Company Name: Humana Inc. Services: 80061, 82962, 99401

    Promotional Code(s): HUVT Valid Dates: 1/1/2012

    12/31/2012

    Kentucky Health Department Provider must scan this voucher into the patient record and

    enter the following information for record:

    ; Height

    ; Weight

    ; BMI

    ; Blood Pressure

    ; Waist Circumference,

    ; Total Cholesterol - HDL, LDL, Triglycerides, Total Chol / HDL ratio

    ; Glucose

All results need to be entered into the Patient Registration and Patient Encounter along with member first

    name, last name, date of birth, gender, and member ID from the member’s Humana card.

This voucher only applies to the services and promotional codes listed above. All other Health

    Department services are to be charged at standard rate.

Vitality Check Consent Form

    Member Name: ___________________________________ __ Member E-mail: _____________________________

    Member Date of Birth: _____________________________ Phone #: _____________________________________

    Member Address:____________________________________________________________________________________________

    Humana ID number:_______________________________ Group #:_____________________________________

    Primary Care Provider: ________________________________ Number in Household: _________________________ Measurements Required:

    Height Weight

    Waist Circumference Blood Pressure

    Total Cholesterol Triglycerides

    HDL LDL

    The _________________County Health Department has my permission to complete the screening required for HumanaVitality, Vitality Check, and my permission to forward

    my information, including the screening results, to the HumanaVitality program.

    Member Signature: __________________________________________________________________________

    Date of Vitality Check: ______________________________________________________________________

Report this document

For any questions or suggestions please email
cust-service@docsford.com