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Health Risk Appraisal Questionnaire
HMRC Version

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. You may return here to see your current report whenever you wish.

Your privacy comes first! Your Last Name and Employee ID are required to confirm your eligibility to use this Health Risk Appraisal (HRA). Beyond this purpose, your information is considered anonymous. It is held in confidence by the University of Michigan Health Management Research Center and otherwise is used only in an aggregate, anonymous form for scientific research and benchmarking purposes.

By completing this HRA you are authorizing the transfer of personal data to the University of Michigan Health Management Research Center. None of your personal identifiable health information will be shared with your employer. Your employer may receive your name and Employee ID only for the purpose of administering and awarding any eligible incentive for completing the Health Risk Appraisal. Your individual Health Risk Appraisal information may be used by wellness vendor program administrators for your employer's health management programs as well as other related services.

Last Name Employee ID
Please enter your Employee ID in the text box to the right.

Michigan CAT employees: enter your Year of Birth plus Last 4 digits of Social Security Number (YYYY####), eg 19509999

WSU employees: enter your 9-digit Banner ID

OHM employees: enter your 6-digit Employee ID Number

BullsEye employees: enter your Year of Birth plus Last 4 digits of Social Security Number (YYYY####), eg 19509999

Romeo Rim employees: enter your Social Security Number

MCTWF employees: enter your Last 4 digits of Social Security Number (####), eg 9999

Gestamp employees: enter your Year of Birth plus Last 4 digits of Social Security Number (YYYY####), eg 19509999

ANXeBusiness employees: enter your Employee File Number

Chemical Bank employees/spouses: Employees enter your 5-digit Employee Number, eg 12345; Spouses enter the employee's 5-digit Employee Number with "10" in front, eg 1012345

Allied Human Services employees: enter your Year of Birth plus First 4 digits of Street Address Number (YYYY####), eg 19506809 (if the number is three digits, say 680, then add a zero to the end, so 6800; if the address is five digits, say 68098, then drop the last digit, so 6809)
Employee ID
Employer
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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Developed by the University of Michigan Health Management Research Center

Apr 18, 2014; 14:11:47 EDT Problems: problems@www.hmrc.kines.umich.edu