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New Life Center for Bariatric Surgery Patient Weight Loss & Medical History Questionnaire NAME: Sex: M F Age: DOB: Work Phone: Home Phone: Current Weight: Current Height BMI Date of Initial Interest

How to fill out 17 bariatric medical history

How to fill out 17 bariatric medical history:

1. Start by providing your personal information such as your full name, date of birth, and contact information.
2. Next, provide details about your medical history including any pre-existing medical conditions, past surgeries or procedures, and any current medications you are taking.
3. Include information about your weight history, including any previous attempts at weight loss and the success or failure of these attempts.
4. Provide details about any previous bariatric surgeries or procedures you have undergone, including the type of surgery and the date it was performed.
5. Include information about any other significant medical conditions you have, such as heart disease, diabetes, or sleep apnea.
6. Describe any allergies or intolerances you have to medications or anesthesia, as this information is crucial for your safety during the bariatric procedure.
7. Provide details about your lifestyle habits, including your diet and exercise routine. This information will help the healthcare team understand your current habits and develop a personalized plan for you.
8. Include information about your mental health, including any history of depression, anxiety, or eating disorders. This information is important as it can impact your overall well-being and success with the procedure.
9. Lastly, sign and date the form to indicate that the information provided is accurate and complete.

Who needs 17 bariatric medical history?

1. Individuals who are considering undergoing bariatric surgery or procedures may need to fill out a 17 bariatric medical history form. This includes individuals who are significantly overweight and have struggled to lose weight through other methods.
2. Patients who have previously undergone bariatric surgery and are seeking additional procedures or follow-up care may also be required to provide a detailed medical history.
3. Healthcare providers and bariatric surgeons use this information to assess a patient's candidacy for the procedure, identify any potential complications, and develop a personalized treatment plan that considers the individual's unique medical history.

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What is 17 bariatric medical history?

17 bariatric medical history is a record of a patient's medical background and information related to bariatric procedures.

Who is required to file 17 bariatric medical history?

Patients who are undergoing bariatric procedures are required to file 17 bariatric medical history.

How to fill out 17 bariatric medical history?

17 bariatric medical history can be filled out by providing accurate and detailed information about the patient's medical history, previous bariatric procedures, current health status, and any other relevant information.

What is the purpose of 17 bariatric medical history?

The purpose of 17 bariatric medical history is to ensure that healthcare providers have a comprehensive understanding of the patient's medical background before proceeding with bariatric procedures.

What information must be reported on 17 bariatric medical history?

Information such as previous medical conditions, surgeries, medications, allergies, current health status, and any other relevant medical information must be reported on 17 bariatric medical history.

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