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HPUPH Medicare patient assessment form

Access the HPUPH Medicare Patient Assessment Form here

We suggest you bookmark this form for easy access in the future.

Program Summary

Providing an annual wellness visit to patients with HealthPartners UnityPoint Health (HPUPH) Medicare Advantage coverage helps develop a personalized prevention plan to prevent disease and disability based on a patient’s current health and risk factors. The data collected during this visit helps to coordinate care, improve quality, and provide a better experience for those people that we serve together.

The HPUPH Medicare Patient Assessment Form is a simple collection tool that allows providers to enter key information and attach supporting documentation. The form should be completed within 60 days of the annual wellness visit. We suggest you bookmark the form for easier access in the future.