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Physician/office staff signature date printed name or stamp phone physicians/office staff can use the. Web the purpose of a chronic condition verification form is to confirm that an individual has a medical condition that. Via the availity provider portal, or. Web there are four convenient ways to send the verification of chronic condition to humana: Web chronic condition verification form provider name one of your patients has elected to enroll in a health net chronic special. Web mi medicare id m m d d y y y y please verify the patient’s qualifying conditions (check all that apply) ° diabetes °. Web health care professionals can access forms for unitedhealthcare plans, including commercial, medicaid, medicare and.