PSMAS HRA SURVEY

Wellness HRA Survey


Fill in your details to become part of PSMAS' Health Risk Assessment (HRA) survey. Your information will not be used for an other use and is confidentially secured.


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Demographics
MEDICAL HISTORY
Beneficiaries
Beneficiary Name
If on the following chronic disease(s) (Diabetes, Hypertension, Cancer, Chronic back, Stress and mental health problems), kindly list medicine
FAMILY AND SOCIAL HISTORY
HEALTH AND LIFESTYLE MANAGEMENT
BEHAVIOURAL-READINESS TO CHANGE

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