Understanding Your Health Needs

Health Information Form

Sunflower wants you to get your best care. One way we do this is by asking you to fill out the Health Information Form.

The Health Information Form helps us assess your needs and whether you need any extra services or tools. You can earn My Health Pays dollars for answering these questions!

Where to Find the Health Information Form

You can complete the form in one of several ways:

• Log in to the Sunflower Secure Member Portal. Click the link that says “Let Us Know.” From there, select the form that says “Health Risk Screening.”
  OR
• Look for the form in your new member welcome packet. Complete the form and send it back to us in the postage-paid envelope provided.
  OR
• Download the form below, complete it and send it back to us in any of these ways:
  • Mail to Medical Management Notifications, PO Box 2010, Farmington MO 63640-9706
  • Fax (toll-free) to 1-855-581-2246
  • Email to SunflowerPHCM@sunflowerhealthplan.com

OR

• Call us toll free at 1-877-644-4623 (TTY 711). We can go through the form questions over the phone. Or you can schedule an in-person visit to complete it.

Download the Health Information Form

• Members Aged 18 and Older:
  • Adult Health Information Form – English (PDF)
  • Adult Health Information Form – Spanish (PDF)
• Members Under Age 18
  • Pediatric Health Information Form – English (PDF)
  • Pediatric Health Information Form – Spanish (PDF)

KanCare also has a health risk screening tool. We may call you to complete this screening.

If you have questions about the form, please call Customer Service toll free at 1-877-644-4623 (TTY 711).