City of Yakima Health Screening Attestation

Read the Rules

After completing the incentive requirements submit the attestation e-card below

Dates will be checked and your submission will be used to validate timely completion. Missing or false validation will be disqualified.

City of Yakima Health Screening E-Card

Retiree Employee Number

Name

First Last

I understand that by checking the boxes below I am attesting to completion

Myself

My Spouse

Registered for miBenefits

Yes

Date completed base Line lab work no later then June 30th

Date completed

Date completed timely miCare follow up appointment after blood draw

Date completed online Health Risk Assessment

Date completed

Annual Dentist Visit

Date

Phone

This field is for validation purposes and should be left unchanged.