Humana Practitioner Assessment Form (PAF) - Patient Assessment and Medical Documentation Guide

Sep 30, 2026

Humana Practitioner Assessment Form (PAF) provides a structured template for comprehensive health assessment during an annual face-to-face or telehealth visit for Humana Medicare Advantage-covered patients. The form draws on elements aligned to Annual Wellness Visit and HEDIS measures, supporting complete and accurate medical record documentation. It helps improve diagnosis coding specificity, identify opportunities to enhance patient care, strengthen care coordination, and facilitate access to Humana care management programs.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages17

Reading Time43 min

AccessFree to download

What is the Humana PAF?

Why should I complete the PAF?

How do I complete the PAF?

Should I submit a claim?

Patient information and visit details

Patient demographics and vital signs

Medical history, medications, and risk review

Humana Practitioner Assessment Form (PAF) What is the Humana PAF? The Humana Practitioner Assessment Form (PAF) is intended to guide a comprehensive health assessment. The form consists of elements from the Annual Wellness Visit and Healthcare Effectiveness Data and Information Set (HEDIS®) measures. The form can be used by physiciansand other healthcare providers to help document vital information for Humana Medicare Advantage-covered patients during an annual face-to-face or telehealth visit. The Humana PAF is a stand-alone medical record, which should include supporting documentation for all services billed in order to capture the true health status of the patient. Why should I complete the PAF? The PAF serves as a concise template that helps to ensure all the elements of a comprehensive health and quality assessment are documented, while assisting in HEDIS measurement closure. Completion of the form enhances complete and accurate medical record documentation, which allows diagnosis coding to the highest level of specificity and identifies opportunities to positively impact patient care with HEDIS and Star Ratings measures. It can help improve coordination of care and help patients access applicable Humana care management programs. How do I complete the PAF? • Ensure you are using the most updated PAF. The current version of the PAF can be found on Humana’s website at [https://provider.humana.com/working-with-us/quality-resources](https://provider.humana.com/working-with-us/quality-resources or on)[ or on](https://provider.humana.com/working-with-us/quality-resources or on) the Availity Essentials portal by selecting the Humana “Resources” [tab at](tab at apps.availity.com/availity/web/public.elegant.login)[ ](tab at apps.availity.com/availity/web/public.elegant.login)[apps.availity.com/availity/web/public.elegant.login](tab at apps.availity.com/availity/web/public.elegant.login). • Contact your assigned Humana-covered patient to schedule him or her for an appointment. • Complete the Humana PAF during a face-to-face encounter or telehealth visit between a patient and a licensed medical doctor (M.D.), doctor of osteopathy (D.O.), physician assistant (PA) or nurse practitioner (NP) . • Examine, evaluate and treat the patient as you normally would, being sure to assess all of his or her chronic health conditions, if any, as well as any acute conditions that may be present. • Ensure that the assessment form is completed in its entirety and signed by the rendering healthcare provider. • Attach additional documentation as needed (see User Guide for instructions) . • Submit the completed assessment form to Humana by one of the two available options. (See page 13 for instructions.) • Place the completed assessment form in the patient’s medical record. Should I submit a claim? Yes, a claim must be submitted with Current Procedural Terminology (CPT®) code 96160 in conjunction and on the same claim with the appropriate office visit, evaluation and management code (E/M) or Annual Wellness Visit code indicating a face-to-face visit occurred (see page 13 for instructions) . HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA) . If you have additional questions, please contact your Humana market representative. 1 989602ALL0426 Fax completed forms to Humana at 888-838-2236 Patient name: Date of service: / / Humana member ID: Date of birth: / / Humana Practitioner Assessment Form Reason for visit (mark all that apply): Initial AWV Subsequent AWV Preventive physical exam Other Patient demographics and vital signs Gender: Male Female Age: Race/ethnicity: Hispanic/Latino American Indian Alaska Native Black/African American African Asian Asian Indian Native Hawaiian Other Pacific Islander White/Caucasian Other How would you rate your overall health over the past month Excellent Good Fair Poor Height: [f

FAQs

What is the purpose of the Humana Practitioner Assessment Form (PAF)?

The PAF is intended to guide a comprehensive health assessment and ensure elements of health and quality assessment are documented for HEDIS measurement closure.

When and by whom should the PAF be completed?

Complete the PAF during a face-to-face encounter or telehealth visit between a patient and a licensed medical doctor, doctor of osteopathy, physician assistant, or nurse practitioner.

What steps are required after completing the PAF?

Ensure the form is completed in its entirety, signed, place it in the patient’s medical record, and submit it to Humana using one of the available options.

Sep 30, 2026

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