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Health Risk Appraisal Questionnaire

Before beginning this questionnaire, please have your medical information at hand, including your height, weight, approximate dates of most recent preventive services and health screenings, and blood pressure and cholesterol measurements, if known. While none of this information is required, including it will make your HRA Profile more accurate and complete.

You may submit a questionnaire only when you are eligible. You will be informed of eligibility at the appropriate time. The HRA will be open for taking from March 24, 2014 - March 31, 2014 only. You may return here to see your current report whenever you wish, but you will not be able to complete a new HRA after October 28.

Your Last Name and Last 5 digits of Social Security Number are required to confirm your eligibility to use this HRA.

Additionally, by completing this Health Risk Appraisal (HRA) you are also authorizing the following: (1) the transfer of your personal data to the University of Michigan Health Management Research Center; (2) notification of your participation in this HRA to Oswald Companies and First Source; and (3) the notification to Oswald Companies and First Source of your qualification status (based on your individual biometric screening results) for purposes of determining your health premium credits for 2014.

IF YOU ARE UNABLE TO SUCCESSFULLY LOGIN, PLEASE CONTACT YOUR FACILITIES HR DESIGNEE IMMEDIATELY.

Last Name Last 5 digits of Social Security Number
HRA Password
For the privacy of your information,
a. If this is your first time here, please enter any password of your choice, using at least four letters or digits. Record and save this password to use when you return here other times. Enter your chosen password twice, once in each box.
b. If you've already registered a password, please enter it once here. This password is not required to enter to complete a questionnaire. However, without it, for the privacy of your information, your report will not include any comparison results from your previous questionnaire.


I've lost my password

To personalize your questionnaire:

Sex
Cigarette Smoking
How would you describe your cigarette smoking habits?
Still smoke cigarettes
Used to smoke cigarettes
Never smoked cigarettes

The Health Risk Appraisal is not a substitute for a medical exam. If you have health concerns or if the report raises questions, please consult your physician or a health professional to review the results with you.

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Apr 24, 2014; 12:56:57 EDT Problems: problems@www.hmrc.kines.umich.edu