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Anthem Health Risk Assessment

Anthem Health Risk Assessment

Name
Address
General Health
How would you rate your overall health?
In the past three months, have you gone to an emergency room for care?
Were you admitted to the hospital anytime within the last 6 months?
Have you ever been diagnosed with Diabetes or blood sugar problems?
Have you ever been diagnosed with Coronary Artery Disease or other heart problems?
In the last 3 months, how many unplanned admissions to the hospital or Emergency Room for mental health or substance use issues have you had?
Do you think you have a problem with alcohol or drugs?
Have you fallen two or more times in the last 3 months?
Do you require help with daily living skills?
Do you have the support that you need?