Get the free BARIATRIC CARE CENTER REFERRAL FORM - summahealth

BARIATRIC CARE CENTER REFERRAL FORM Please complete section 1 to refer a patient to Summat Bariatric Care Center. FAX TO 3303756593. Please let the patient know that they will be contacted to schedule

How to fill out bariatric care center referral

How to fill out a bariatric care center referral:

1. Obtain the referral form: The first step is to obtain the referral form from your healthcare provider or the bariatric care center. This form is usually available online or can be obtained in person.
2. Fill in personal information: Start by filling in your personal information, including your name, address, contact number, and date of birth. It is important to provide accurate information to ensure proper communication and identification.
3. Provide medical history: Next, provide a detailed medical history including any previous surgeries, medical conditions, and medications you are currently taking. This information helps the bariatric care center understand your health status and any potential risks or contraindications for surgery.
4. Describe weight loss efforts: In this section, describe the various weight loss methods you have tried in the past, such as dieting, exercise programs, and previous weight loss surgeries. It is important to be honest and provide as much detail as possible to help the bariatric care center assess your eligibility for bariatric surgery.
5. Include supporting documentation: If you have any relevant medical reports, lab results, or previous referrals, make sure to attach them to the referral form. This additional information can provide a comprehensive understanding of your medical history and aid in the evaluation process.
6. Obtain necessary signatures: Before submitting the referral form, ensure that you have properly signed it and that any required signatures from your healthcare provider or referring physician are obtained. This verifies that you authorize the referral and that your healthcare provider supports your decision to seek bariatric care.

Who needs bariatric care center referral?

1. Individuals with severe obesity: A bariatric care center referral is typically needed for individuals who have severe obesity, defined as having a body mass index (BMI) of 40 or higher, or a BMI of 35-39.9 with significant obesity-related health issues. The referral helps initiate the evaluation process to determine if bariatric surgery is an appropriate treatment option.
2. Those seeking surgical weight loss: Bariatric care center referrals are most commonly required for individuals seeking surgical weight loss options such as gastric bypass, gastric sleeve, or gastric banding procedures. These surgeries are typically reserved for individuals who have tried and failed to lose weight through non-surgical methods.
3. Patients with no contraindications for surgery: The referral is necessary to ensure that patients do not have any contraindications for bariatric surgery. Medical conditions such as uncontrolled hypertension, heart disease, or certain psychological disorders may affect a person's candidacy for surgery.

It is important to consult with your healthcare provider to determine if a bariatric care center referral is necessary and to discuss the best treatment options for your specific situation.

For pdfFiller’s FAQs

What is bariatric care center referral?

The bariatric care center referral is a recommendation or request to refer a patient to a specialized center that focuses on the treatment of obesity and related conditions.

Who is required to file bariatric care center referral?

Healthcare providers, such as primary care physicians, specialists, or surgeons, are typically responsible for filing a bariatric care center referral.

How to fill out bariatric care center referral?

The referral form usually requires the patient's medical history, current health status, reasons for referral, and any relevant test results or documentation.

What is the purpose of bariatric care center referral?

The purpose of a bariatric care center referral is to ensure that patients with obesity receive specialized care and treatment from experienced healthcare professionals.

What information must be reported on bariatric care center referral?

The referral should include the patient's demographic information, medical history, current medications, allergies, recent test results, and the reason for the referral.

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