Get the free Obesity Referral Form - Health Plan - healthplan

Obesity Referral Form Please complete the information below to refer your patient to The Health Plan for nutrition / weight management. Fax to (740) 6955297 Attn: Joy Gillespie, R.N., B.S.N., Medical

How to fill out obesity referral form

How to fill out an obesity referral form:

1. Start by providing your personal information, including your name, date of birth, address, and contact details. Make sure all the information is accurate and up to date.
2. Next, indicate your height and weight, as this is crucial in assessing your body mass index (BMI) and determining if you fall under the category of obesity.
3. Provide any relevant medical history, including any pre-existing conditions or medications you are currently taking. This information helps healthcare professionals understand your overall health and plan the appropriate treatment.
4. Describe your lifestyle and dietary habits, including any previous attempts at weight loss or obesity management. This information helps shape the referral to suitable programs or medical specialists.
5. If you have any specific concerns or goals related to obesity management, be sure to express them in the form. This allows healthcare providers to address your individual needs and preferences.
6. Finally, sign and date the form to acknowledge that the provided information is accurate and complete. Ensure you understand the purpose of the form and any potential risks or benefits associated with the referral.

Who needs an obesity referral form?

1. Individuals who are struggling with obesity or overweight and seek professional assistance to address their weight-related concerns.
2. Those who have been advised by their primary healthcare provider or healthcare team to pursue specialized treatment for obesity.
3. People with underlying medical conditions or risk factors associated with obesity, such as diabetes, heart disease, or sleep apnea, who may require additional support for managing their weight and overall health.

Remember, it is essential to consult with a healthcare professional to determine if filling out an obesity referral form is appropriate for your specific situation.

For pdfFiller’s FAQs

What is obesity referral form?

The obesity referral form is a document that allows healthcare professionals to refer individuals who are obese to weight management programs or specialists for further treatment and support.

Who is required to file obesity referral form?

Healthcare professionals such as doctors, nurses, and dietitians are required to file the obesity referral form for individuals who are obese.

How to fill out obesity referral form?

To fill out the obesity referral form, healthcare professionals must provide information about the patient's medical history, current weight, height, and any existing health conditions.

What is the purpose of obesity referral form?

The purpose of the obesity referral form is to help individuals who are obese access the necessary resources and support to manage their weight and improve their overall health.

What information must be reported on obesity referral form?

The obesity referral form must include the patient's personal information, medical history, current weight, height, any existing health conditions, and the reason for the referral.

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