Biometric Screening Consent Form

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University of Virginia Health Plan
Biometric Screening
Consent Form

University of Virginia Health Plan

Biometric Screening

Consent Form

NOTE: Completing this form will take you to the scheduling page for the biometric screenings.

 

Please read the following disclosure statement.

The biometric screening, together with Aetna's health assessment, is designed to provide feedback that will help you evaluate your current lifestyle, identify health risks, and decide where and how to make improvements. It does not provide a diagnosis of medical problems. A follow-up visit with your primary care physician to confirm the results of the screening and obtain further medical help is highly recommended.

I understand that my biometric screening data will be released to Aetna for the purposes of follow-up health education and disease management, data aggregation for program improvement purposes, and/or for purposes of updating my online Personal Health Record. The University of Virginia will be advised of my participation in this biometric screening for purposes of qualification for rewards. My biometric screening results may be disclosed to partners including, UVA-WorkMed, UVa Nutrition, the Faculty & Employee Assistance Program, Intramural-Recreational Sports, the School of Nursing, and Alere Wellbeing, that are engaged by the UVa Health Plan for follow-up health education and disease management coaching (if eligible). All partners involved having access to this biometric screening data are obligated to protect such information from unauthorized access or use.

Your completion and submission of the information below indicates that you voluntarily agree to all of the preceding provisions.