Health Evaluation and Test Records

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This simple tool can be used to record the types of services, tests and their results to help you or your loved one manage their diabetes care. There is also room to record any vaccines you or your loved may have received, including the results from those vaccines. Remember to take this record to your doctor appointments, so your doctor can make sure you are up to date with your tests and vaccines.

Health Evaluation Test Records PDF
Health Evaluation Test Records Spanish PDF

Disclaimer: The information about educational or therapeutic approaches is provided for educational purposes only. Certain treatments may or may not be covered through your benefit plan. Coverage typically depends on your plan specifications and relevant guidelines maintained in relation to your benefit plan.

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What is a reference number?

When you register on this site, you are assigned a reference number. This number contains your profile information and helps UnitedHealthcare identify you when you come back to the site.

If you searched for a plan on this site in a previous session, you might already have a reference number. This number will contain any information you saved about plans and prescription drugs. To use that reference number, click on the "Change or view saved information" link below.

You can retrieve information from previous visits to this site, such as saved drug lists and Plan Selector information.