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Hartford Personal Health Statement

Employees must complete this form if they have requested insurance coverage for themselves and are required to show evidence of good health. For questions about how to complete this form, call Eric Smith at MGIS at 800-969-6447, ext. 165. PLEASE NOTE: The Employer section of the Personal Health Statement should be left blank when submitting to MGIS. MGIS will have this required information in their database. 

Form Name	Format
Hartford Personal Health Statement	PDF

* Some Duke HR forms may require you to list your Duke Unique ID.  If you do not know or are unsure of your Duke Unique ID, you can look it up here. ** Some forms available on this web site are in Adobe Portable Document Format (PDF).  You will need Adobe Acrobat Reader to view and print these forms.

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